Healthcare Provider Details

I. General information

NPI: 1346162260
Provider Name (Legal Business Name): CLIFFORD FERRELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 STEVE REYNOLDS BLVD
DULUTH GA
30096-4506
US

IV. Provider business mailing address

480 WARM SPRINGS CT
LOGANVILLE GA
30052-8232
US

V. Phone/Fax

Practice location:
  • Phone: 770-931-6408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number294571
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: