Individual
JEAN ROBERT FERDINAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3334 HIGHWAY 155, LOCUST GROVE, GA 30248-3513
(770) 305-7929
(770) 305-7969
Mailing address
4303 JODECO RD, MCDONOUGH, GA 30253-8297
(770) 898-7840
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
64216
GA
207QS0010X
Sports Medicine (Family Medicine) Physician
31037
AL
207QS0010X
Sports Medicine (Family Medicine) Physician
64216
GA
207QS0010X
Sports Medicine (Family Medicine) Physician
7553
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003111758C
—
GA
01
—
12263436
CAQH
—
Enumeration date
07/13/2010
Last updated
05/16/2019
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