Maryann Johnston Fedack, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

54370 Issued in GA

Practice address

1111 Alderman Drive
Ste. 250
Alpharetta, GA 30005

Phone

(678) 527-1555

Fax

(678) 527-1559

NPI assigned

Apr 20, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: maryann.fedack.1@14597.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pediatric Physicians, P.C.

  • Primary Care Clinic/Center
  • Roswell, GA
  • NPI 1285768184
  NPD (past)
• Snapfinger Woods Pediatric Associates P C

  • Pediatrics Physician
  • Decatur, GA
  • NPI 1649437609
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528156800000",
    "number": "1194780064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 ALDERMAN DRIVE",
            "address_2": "STE. 250",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "30005",
            "telephone_number": "678-527-1555",
            "fax_number": "678-527-1559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 ALDERMAN DRIVE",
            "address_2": "STE. 250",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "30005",
            "telephone_number": "678-527-1555",
            "fax_number": "678-527-1559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDACK",
        "first_name": "MARYANN",
        "middle_name": "JOHNSTON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-20",
        "last_updated": "2018-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "057370",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "54370",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003122405B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Farzad
• Nafiseh Farzin Nasab, M.D.
• Eduard Fatakhov, M.D.
• Arezou Fatemi, M.D.
• David Febles Jr., LAMFT
• Federal Injury Behavioral Health PLLC
• Feed the Kids Inc
• Susan Lisa Feig, PH.D.
• Shabnam Feizi
• Diane Johnson Felder, M.D.

• Pediatrics Physician in Alpharetta, GA
• Providers in Alpharetta, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.