Basic Information
| Provider Information | |||||||||
| NPI: | 1356306377 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERRARA | ||||||||
| FirstName: | ANTHONY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 52802 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303550802 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2140 PEACHTREE RD NW STE 232 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4049926144 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 10/27/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 042242 | GA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 32564 | CO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 56976 | AZ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000720596N | 05 | GA | MEDICAID | 007659 | 01 | CO | KAISER COMMERCIAL NUMBER | OTHER | 01325646 | 05 | CO | MEDICAID |