Healthcare Provider Details

I. General information

NPI: 1396175873
Provider Name (Legal Business Name): MARY GAIL FERRA NPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 E 16TH AVE
CORDELE GA
31015-1514
US

IV. Provider business mailing address

63 FOX RIDGE RD
DOUGLAS GA
31535-5630
US

V. Phone/Fax

Practice location:
  • Phone: 229-273-8881
  • Fax: 229-273-8985
Mailing address:
  • Phone: 912-383-9953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License NumberRN040735
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: