Provider Demographics
NPI:1659552313
Name:F C FERGUSON MD PC
Entity Type:Organization
Organization Name:F C FERGUSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:CAMBELL
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-860-9066
Mailing Address - Street 1:3623 J DEWEY GRAY CIR
Mailing Address - Street 2:STE#313
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6511
Mailing Address - Country:US
Mailing Address - Phone:706-860-9066
Mailing Address - Fax:706-855-8842
Practice Address - Street 1:3623 J DEWEY GRAY CIR
Practice Address - Street 2:STE#313
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6511
Practice Address - Country:US
Practice Address - Phone:706-860-9066
Practice Address - Fax:706-855-8842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19161208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty