Provider Demographics
NPI:1386767382
Name:FERRELL, NATHAN LEON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:LEON
Last Name:FERRELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 DURHAM LAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-6459
Mailing Address - Country:US
Mailing Address - Phone:770-722-4356
Mailing Address - Fax:
Practice Address - Street 1:211 TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1328
Practice Address - Country:US
Practice Address - Phone:770-253-8562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist