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General NPI Number Information
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NPI Number | 1982800884
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Entity Type | Organization
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Legal Business Name | TALLADEGA NEPHROLOGY, LLC
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 210 NORTH ST W
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City | TALLADEGA
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State | AL
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Zip | 35160-2083
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Country | US
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Telephone | 256-521-1996
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Fax |
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Provider Business Mailing Address
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Address Line | 210 NORTH ST W
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City | TALLADEGA
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State | AL
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Zip | 35160-2083
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Country | US
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Telephone | 256-521-1996
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDRE D FERIA
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Credential | M.D.
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Telephone | 256-521-1997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 21771
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License Number State | AL
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