Provider Demographics
NPI:1023213022
Name:WILLIAM J. FERGSON, JR., MD PC
Entity Type:Organization
Organization Name:WILLIAM J. FERGSON, JR., MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOSS
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:256-237-8811
Mailing Address - Street 1:901 LEIGHTON AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5700
Mailing Address - Country:US
Mailing Address - Phone:256-237-8811
Mailing Address - Fax:256-237-8823
Practice Address - Street 1:901 LEIGHTON AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5700
Practice Address - Country:US
Practice Address - Phone:256-237-8811
Practice Address - Fax:256-237-8823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15223174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000086860Medicaid
AL1821190729OtherNPI
ALJ274OtherMEDICARE GROUP NUMBER
AL1821190729OtherNPI
ALJ274OtherMEDICARE GROUP NUMBER