Jackie Feckoury, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN009923 Issued in GA

Practice address

203 Millard Farmer Ind Blvd
Newnan, GA 30263-1012

Phone

(770) 746-3342

NPI assigned

Oct 24, 2017

Last updated

Aug 18, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1508803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692316800000",
    "number": "1366954844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "156 LORETTA LN",
            "city": "LUTHERSVILLE",
            "state": "GA",
            "postal_code": "302512110",
            "telephone_number": "770-998-1481",
            "fax_number": "678-929-3191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 MILLARD FARMER IND BLVD",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302631012",
            "telephone_number": "770-746-3342"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "156 Loretta Ln",
            "address_purpose": "LOCATION",
            "city": "Luthersville",
            "state": "GA",
            "postal_code": "302512110",
            "country_code": "US",
            "telephone_number": "770-998-1481",
            "fax_number": "678-929-3191",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FECKOURY",
        "first_name": "JACKIE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-10-24",
        "last_updated": "2023-08-18",
        "certification_date": "2023-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN009923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family Physicians at Summer Grove
• Charles Couch Farmer, MD
• Karanda Lyke Farmer
• Ayesha Afsar Faruqi
• Emily Rachel Faulkner, NP-C
• Lauren Elizabeth Fellows, NP
• Stephen Fellows, CRNA
• Carole M. Felt
• Megan Louise Fenceroy, NP-C
• Ferman Family Dentistry PC

• General Practice Dentistry in Newnan, GA
• Providers in Newnan, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.