Provider Demographics
NPI:1164945028
Name:FERGUSON, TAVARUS (MA, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:TAVARUS
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:MA, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE UNIVERSITY HEIGHTS
Mailing Address - Street 2:JUSTICE CENTER, CPO #2600
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ONE UNIVERSITY HEIGHTS
Practice Address - Street 2:JUSTICE CENTER CPO #2600
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804
Practice Address - Country:US
Practice Address - Phone:253-495-5248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-3025207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine