Provider Demographics
NPI:1144916065
Name:FEASTER, PAUL LEE III
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:LEE
Last Name:FEASTER
Suffix:III
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 1:825 S POST RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-6932
Mailing Address - Country:US
Mailing Address - Phone:704-481-7502
Mailing Address - Fax:
Practice Address - Street 1:825 S POST RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6932
Practice Address - Country:US
Practice Address - Phone:704-481-7502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle