Basic Information
| Provider Information | |||||||||
| NPI: | 1891395356 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FELTON | ||||||||
| FirstName: | JEFFERY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3643 GALDWAY DR | ||||||||
| Address2: | |||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300395102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2293220476 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5935 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | STONE MOUNTAIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300833429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042606149 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2020 | ||||||||
| LastUpdateDate: | 10/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH027226 | GA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.