Provider Demographics
NPI:1881230993
Name:FERGUSON, JOAN JANELLE (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:JANELLE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4912 CLAIRMONT AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-4421
Mailing Address - Country:US
Mailing Address - Phone:205-602-9977
Mailing Address - Fax:205-592-8835
Practice Address - Street 1:85 BAGBY DR STE 302
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-3735
Practice Address - Country:US
Practice Address - Phone:205-602-9977
Practice Address - Fax:205-592-8835
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-24
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2861133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered