Provider Demographics
NPI:1093432916
Name:JOHNSON-FERGUSON, CARLA (RN, CASE MANAGER)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:
Last Name:JOHNSON-FERGUSON
Suffix:
Gender:F
Credentials:RN, CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 NORRIS LANDING DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-5709
Mailing Address - Country:US
Mailing Address - Phone:706-951-2908
Mailing Address - Fax:
Practice Address - Street 1:3374 PEACH ORCHARD RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-4875
Practice Address - Country:US
Practice Address - Phone:706-951-2908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN197795163WC0400X
SC92542163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty