Provider Demographics
NPI:1487703245
Name:MUSNGI, FELIPE REYES
Entity type:Individual
Prefix:DR
First Name:FELIPE
Middle Name:REYES
Last Name:MUSNGI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 JEFFERSON STREET
Mailing Address - Street 2:
Mailing Address - City:STATHAM
Mailing Address - State:GA
Mailing Address - Zip Code:30666
Mailing Address - Country:US
Mailing Address - Phone:770-725-7994
Mailing Address - Fax:770-725-7994
Practice Address - Street 1:337 JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:STATHAM
Practice Address - State:GA
Practice Address - Zip Code:30666
Practice Address - Country:US
Practice Address - Phone:770-725-7994
Practice Address - Fax:770-725-7994
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00234737AMedicaid
GA00234737AMedicaid