Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 53439 | GA |
N | 208600000X | Surgeon | 53439 | GA |
Y | 2086S0102X | Surgical Critical Care | 53439 | GA |
NPI | 1306956842 |
---|---|
Provider Name | Colville H. Ferdinand |
First Address | Augusta, GA 30914-3548 |
Second Address | Augusta, GA 30909-2205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10001269B | (05) | GA |
G53439 | (05) | SC |
H89342 | (02) |