Provider Demographics
NPI:1760990915
Name:DANIEL, ALEXANDRA FEREBEE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:FEREBEE
Last Name:DANIEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 GARDENS PL
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-6162
Mailing Address - Country:US
Mailing Address - Phone:904-463-3001
Mailing Address - Fax:
Practice Address - Street 1:148 BILL CARRUTH PKWY STE 120
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-3756
Practice Address - Country:US
Practice Address - Phone:770-445-5666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL363AS0400X
GA10289363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical