Basic Information
| Provider Information | |||||||||
| NPI: | 1124107453 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FEIST | ||||||||
| FirstName: | FREDRIC | ||||||||
| MiddleName: | WARREN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 425 5TH AVE NW | ||||||||
| Address2: | |||||||||
| City: | ATTALLA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359542214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2564927800 | ||||||||
| FaxNumber: | 2564945536 | ||||||||
| Practice Location | |||||||||
| Address1: | 425 5TH AVE NW | ||||||||
| Address2: | |||||||||
| City: | ATTALLA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359542214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2564927800 | ||||||||
| FaxNumber: | 2564945536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2006 | ||||||||
| LastUpdateDate: | 09/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 3258 | AL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 000002083 | 05 | AL | MEDICAID | 51502083 | 01 | BLUE CROSS OF ALABAMA | OTHER | 51002083 | 01 | BLUE CROSS OF ALABAMA | OTHER |