Provider Demographics
NPI:1144502154
Name:FARQUHARSON, FARRAH K (PA-C)
Entity type:Individual
Prefix:
First Name:FARRAH
Middle Name:K
Last Name:FARQUHARSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 CHANDLER CT
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30656-3688
Mailing Address - Country:US
Mailing Address - Phone:305-300-8455
Mailing Address - Fax:
Practice Address - Street 1:10877 WILSHIRE BLVD STE 1100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4368
Practice Address - Country:US
Practice Address - Phone:310-248-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106122363A00000X
GA9695363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004032800Medicaid
FLP01600611OtherRR MCR
FLFN307YMedicare PIN