Provider Demographics
NPI:1487989695
Name:FERRARA, ANTHONY P
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:P
Last Name:FERRARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 KINGS WALK
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-7303
Mailing Address - Country:US
Mailing Address - Phone:404-405-6525
Mailing Address - Fax:
Practice Address - Street 1:3040 HIGHLANDS PKWY SE
Practice Address - Street 2:STE E
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5176
Practice Address - Country:US
Practice Address - Phone:404-405-6525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003084363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical