Healthcare Provider Details

I. General information

NPI: 1235394545
Provider Name (Legal Business Name): GEOFFREY JOHN FERRIS M.ED., B.C.B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 STATE ST # 403
NASHVILLE TN
37203-2984
US

IV. Provider business mailing address

1700 STATE ST # 403
NASHVILLE TN
37203-2984
US

V. Phone/Fax

Practice location:
  • Phone: 615-916-0664
  • Fax: 615-953-2949
Mailing address:
  • Phone: 615-916-0664
  • Fax: 615-953-2949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-9526
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: