MEDICARE: ANGELISHEA FERRELL

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	1041C0700X	Clinical Social Worker	0904018468	VA
2	1041C0700X	Clinical Social Worker	CSW008751	GA

General Provider Information

NPI Number	:	1275463622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELISHEA FERRELL

Provider Business Mailing Address
First Line	:	6169 SOUTHLAND TRCE
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-4975
Country	:	US
Telephone Number	:	470-642-9830
Fax Number	:

Provider Business Practice Location Address
First Line	:	6169 SOUTHLAND TRCE
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-4975
Country	:	US
Telephone Number	:	470-642-9830
Fax Number	:

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

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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Directions to “ ANGELISHEA FERRELL ” Practice Location

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