Provider Demographics
NPI:1750486742
Name:WALID, FERIAL (MD)
Entity Type:Individual
Prefix:
First Name:FERIAL
Middle Name:
Last Name:WALID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4856 GUERRY DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4104
Mailing Address - Country:US
Mailing Address - Phone:478-471-0858
Mailing Address - Fax:478-471-0858
Practice Address - Street 1:110 WOODCREST BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-8824
Practice Address - Country:US
Practice Address - Phone:478-922-6685
Practice Address - Fax:478-922-6686
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA163454222CMedicaid
GA163454222AMedicaid
511G700847OtherMEDICARE PTAN
GA163454222CMedicaid
GAI28974Medicare UPIN