Provider Demographics
NPI:1396175873
Name:FERRA, MARY GAIL (NPC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:GAIL
Last Name:FERRA
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
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Mailing Address - Street 1:63 FOX RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31535-5630
Mailing Address - Country:US
Mailing Address - Phone:912-383-9953
Mailing Address - Fax:
Practice Address - Street 1:804 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-1514
Practice Address - Country:US
Practice Address - Phone:229-273-8881
Practice Address - Fax:229-273-8985
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN040735364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health