Provider Demographics
NPI:1568511020
Name:FERGUS, MARVIN BROWNING (MDIV, THM)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:BROWNING
Last Name:FERGUS
Suffix:
Gender:M
Credentials:MDIV, THM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 PEACHTREE ST NW
Mailing Address - Street 2:STE. 505
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2434
Mailing Address - Country:US
Mailing Address - Phone:404-872-8065
Mailing Address - Fax:404-872-0925
Practice Address - Street 1:1708 PEACHTREE ST NW
Practice Address - Street 2:STE. 505
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2434
Practice Address - Country:US
Practice Address - Phone:404-872-8065
Practice Address - Fax:404-872-0925
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000749106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist