Provider Demographics
NPI:1164530036
Name:FERGUSON, KEVIN R (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:R
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7155 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-0802
Mailing Address - Country:US
Mailing Address - Phone:423-648-9290
Mailing Address - Fax:423-648-9291
Practice Address - Street 1:7155 LEE HWY STE 300
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-0802
Practice Address - Country:US
Practice Address - Phone:423-648-9290
Practice Address - Fax:423-648-9291
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0205032084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
125436100OtherUS DEPARTMENT OF LABOR
TN3054903Medicaid
TN0129073OtherBLUE CROSS
TN3054903Medicaid