Provider Demographics
NPI:1205828134
Name:FERIA, ANDRE D (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:D
Last Name:FERIA
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 1:142 OLD MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-6704
Mailing Address - Country:US
Mailing Address - Phone:706-885-1900
Mailing Address - Fax:706-882-1350
Practice Address - Street 1:142 OLD MILL ROAD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-6704
Practice Address - Country:US
Practice Address - Phone:706-885-1900
Practice Address - Fax:706-882-1350
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048513207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000866203AMedicaid
GA11BDRRMMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
GAF67310Medicare UPIN