Provider Demographics
NPI:1083323042
Name:FERGUSON, THOMAS JAMEL (PA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMEL
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:226 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948-8660
Mailing Address - Country:US
Mailing Address - Phone:919-352-6708
Mailing Address - Fax:
Practice Address - Street 1:4917 S CROATAN HWY STE 1A
Practice Address - Street 2:
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-8996
Practice Address - Country:US
Practice Address - Phone:252-449-6160
Practice Address - Fax:252-449-6161
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2023-04-18
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant