Provider Demographics
NPI:1356542518
Name:FEATHERSTON, CATHERINE BALLARD (MD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:BALLARD
Last Name:FEATHERSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CATHERINE
Other - Middle Name:B
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1001 ATLANTIC AVE STE D
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3652
Mailing Address - Country:US
Mailing Address - Phone:904-206-9354
Mailing Address - Fax:
Practice Address - Street 1:1001 ATLANTIC AVE STE D
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034
Practice Address - Country:US
Practice Address - Phone:904-206-9354
Practice Address - Fax:844-461-6758
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121369207R00000X
GA59798208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA404276OtherWELLCARE
SCG59798Medicaid
GA01067526OtherAMERIGROUP
GAP00406210OtherRAILROAD MEDICARE