Provider Demographics
NPI:1720081516
Name:FERRIS, CHARLES CONN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CONN
Last Name:FERRIS
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:PO BOX 14416
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-1416
Mailing Address - Country:US
Mailing Address - Phone:912-355-8200
Mailing Address - Fax:912-356-6967
Practice Address - Street 1:1934 E MONTGOMERY XRD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-5037
Practice Address - Country:US
Practice Address - Phone:912-355-8200
Practice Address - Fax:912-356-6967
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0300602085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA046139OtherBLUE CROSS BLUE SHIELD
GA00369795BMedicaid
SC300033932OtherRR MEDICARE
SC300033932OtherRR MEDICARE
D45328Medicare UPIN