Healthcare Provider Details

I. General information

NPI: 1801488465
Provider Name (Legal Business Name): MERISSA FERRAR NELMS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 GAINES SCHOOL RD
ATHENS GA
30605-3132
US

IV. Provider business mailing address

870 GAINES SCHOOL RD
ATHENS GA
30605-3132
US

V. Phone/Fax

Practice location:
  • Phone: 706-546-7473
  • Fax: 706-549-0973
Mailing address:
  • Phone: 706-546-7473
  • Fax: 706-549-0973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN122419
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: