MEDICARE: JEREMY FERRIS M.D.

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	2085R0202X	Diagnostic Radiology Physician	25565	AL
2	2085R0204X	Vascular & Interventional Radiology Physician	25565	AL
3	2085R0202X	Diagnostic Radiology Physician	059637	GA

General Provider Information

NPI Number	:	1679647267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY FERRIS M.D.

Provider Business Mailing Address
First Line	:	717 20TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-8920
Country	:	US
Telephone Number	:	706-653-0292
Fax Number	:	706-653-1230

Provider Business Practice Location Address
First Line	:	717 20TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-8920
Country	:	US
Telephone Number	:	706-653-0292
Fax Number	:	706-653-1230

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	03/27/2025

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