Provider Demographics
NPI:1679230981
Name:FERGUSON, BELINDA CLAIRE (PA)
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:CLAIRE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2303 BROOKHAVEN VW NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-5404
Mailing Address - Country:US
Mailing Address - Phone:815-592-0779
Mailing Address - Fax:
Practice Address - Street 1:100 STONEFOREST DR STE 220
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-4881
Practice Address - Country:US
Practice Address - Phone:770-952-8612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant