Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | DN013416 | GA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN013416 | GA |
N | 204E00000X | Oral & Maxillofacial Surgeon | DN013416 | GA |
NPI | 1629073465 |
---|---|
Provider Name | Dr. Eric D Ferrara |
First Address | Griffin, GA 30224-4214 |
Second Address | Griffin, GA 30224-4214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 01/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
178058507A | (05) | GA |
178058507B | (05) | GA |
U96963 | (02) | OH |