Provider Demographics
NPI:1306250857
Name:LEAH JOHNSON MCFERREN, O.D., P.C.
Entity type:Organization
Organization Name:LEAH JOHNSON MCFERREN, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFERREN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-768-3500
Mailing Address - Street 1:1704 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-2014
Mailing Address - Country:US
Mailing Address - Phone:404-768-3500
Mailing Address - Fax:404-768-9104
Practice Address - Street 1:1704 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-2014
Practice Address - Country:US
Practice Address - Phone:404-768-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001216152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000687794AMedicaid
GA202G708056Medicare PIN