MARYANN JOHNSTON FEDACK M.D. NPI 1194780064

NPI Information

NPI: 1194780064
Provider Name: MARYANN JOHNSTON FEDACK, M.D.
Classification: Pediatrics - 208000000X
Entity Type: Individual
Address:
1111 ALDERMAN DRIVE
STE. 250
ALPHARETTA, GA
ZIP 30005
Phone: (678) 527-1555
Get Directions

Maryann Johnston Fedack, M.D. is a pediatrics in Alpharetta, GA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. Maryann Johnston Fedack, M.D. NPI is 1194780064. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1111 ALDERMAN DRIVE
STE. 250
ALPHARETTA, GA
ZIP 30005
Phone: (678) 527-1555
Fax: (678) 527-1559

The enumeration date for this NPI number is 4/20/2006 and was last updated on 6/5/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208000000X	Pediatrics		54370	GEORGIA	Yes
2	208000000X	Pediatrics		057370	GEORGIA	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	003122405B	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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