Provider Demographics
NPI:1073625034
Name:ZERLA, ERIC JAMES (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JAMES
Last Name:ZERLA
Suffix:
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 1:1550 DOCTORS DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4140
Mailing Address - Country:US
Mailing Address - Phone:706-884-2686
Mailing Address - Fax:706-812-0468
Practice Address - Street 1:1550 DOCTORS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4140
Practice Address - Country:US
Practice Address - Phone:706-884-2686
Practice Address - Fax:706-812-0468
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050299208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA959121173EMedicaid