MEDICARE: MR. ANDRE D FERIA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	048513	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205828134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDRE D FERIA MD

Provider Business Mailing Address
First Line	:	142 OLD MILL ROAD
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30241-6704
Country	:	US
Telephone Number	:	706-885-1900
Fax Number	:	706-882-1350

Provider Business Practice Location Address
First Line	:	142 OLD MILL ROAD
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30241-6704
Country	:	US
Telephone Number	:	706-885-1900
Fax Number	:	706-882-1350

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	06/30/2008

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