Provider Demographics
NPI:1164143558
Name:FERGUSON, ALISA BETH (PA-C)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:BETH
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:3320 OLD JEFFERSON RD BLDG 700
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1465
Mailing Address - Country:US
Mailing Address - Phone:706-353-2990
Mailing Address - Fax:706-353-2992
Practice Address - Street 1:220 HAWTHORNE PARK
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2148
Practice Address - Country:US
Practice Address - Phone:706-548-0500
Practice Address - Fax:706-548-3575
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2023-06-09
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Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty