Provider Demographics
NPI:1982831012
Name:A. DREW FERGUSON IV DMD PC
Entity Type:Organization
Organization Name:A. DREW FERGUSON IV DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:A.
Authorized Official - Middle Name:DREW
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:IV
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-643-3294
Mailing Address - Street 1:704 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:31833-1639
Mailing Address - Country:US
Mailing Address - Phone:706-643-3294
Mailing Address - Fax:
Practice Address - Street 1:704 AVENUE C
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:GA
Practice Address - Zip Code:31833-1639
Practice Address - Country:US
Practice Address - Phone:706-643-3294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA110841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty