Provider Demographics
NPI:1942336771
Name:FARRIS, ALTON BRAD III (MD)
Entity type:Individual
Prefix:DR
First Name:ALTON
Middle Name:BRAD
Last Name:FARRIS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EMORY UNIVERSITY HOSPITAL
Mailing Address - Street 2:1364 CLIFTON ROAD NE, ROOM H-188
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322
Mailing Address - Country:US
Mailing Address - Phone:404-712-8843
Mailing Address - Fax:
Practice Address - Street 1:EMORY UNIVERSITY HOSPITAL
Practice Address - Street 2:1364 CLIFTON ROAD NE, ROOM H-188
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-712-8843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-221269207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology