Provider Demographics
NPI:1083197933
Name:CHUNG-FERGUSON, ALTHEA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALTHEA
Middle Name:
Last Name:CHUNG-FERGUSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 PEACHTREE RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1252
Mailing Address - Country:US
Mailing Address - Phone:404-926-3541
Mailing Address - Fax:
Practice Address - Street 1:3637 PEACHTREE RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319-1252
Practice Address - Country:US
Practice Address - Phone:404-926-3541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN168905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily