Provider Demographics
NPI:1356814974
Name:ALSTON, FERRIS ANTWAN
Entity Type:Individual
Prefix:
First Name:FERRIS
Middle Name:ANTWAN
Last Name:ALSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 VERMONT AVE NW STE 1003
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-4927
Mailing Address - Country:US
Mailing Address - Phone:844-381-4432
Mailing Address - Fax:
Practice Address - Street 1:2100 MLK JR AVE S.E.
Practice Address - Street 2:SUITE#100
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020
Practice Address - Country:US
Practice Address - Phone:202-849-1016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC4422334Medicaid