Provider Demographics
NPI:1871592741
Name:FELTON, JIMMIE LEE JR (DPM)
Entity type:Individual
Prefix:DR
First Name:JIMMIE
Middle Name:LEE
Last Name:FELTON
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7033
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-7033
Mailing Address - Country:US
Mailing Address - Phone:229-928-6000
Mailing Address - Fax:
Practice Address - Street 1:922 E JEFFERSON ST
Practice Address - Street 2:SUITE D
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-4780
Practice Address - Country:US
Practice Address - Phone:229-928-6000
Practice Address - Fax:229-928-6369
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000807213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU66783Medicare UPIN
GA1257200001Medicare PIN