Provider Demographics
NPI:1982800884
Name:TALLADEGA NEPHROLOGY, LLC
Entity Type:Organization
Organization Name:TALLADEGA NEPHROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:D
Authorized Official - Last Name:FERIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-521-1997
Mailing Address - Street 1:210 NORTH ST W
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2083
Mailing Address - Country:US
Mailing Address - Phone:256-521-1996
Mailing Address - Fax:
Practice Address - Street 1:210 NORTH ST W
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2083
Practice Address - Country:US
Practice Address - Phone:256-521-1996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21771207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty