Provider Demographics
NPI:1518755735
Name:FERGUSON, KWAMAINE JAMEL
Entity type:Individual
Prefix:
First Name:KWAMAINE
Middle Name:JAMEL
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 KINGSBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:ROEBUCK
Mailing Address - State:SC
Mailing Address - Zip Code:29376-2617
Mailing Address - Country:US
Mailing Address - Phone:864-559-7006
Mailing Address - Fax:
Practice Address - Street 1:119 KINGSBERRY CIR
Practice Address - Street 2:
Practice Address - City:ROEBUCK
Practice Address - State:SC
Practice Address - Zip Code:29376-2617
Practice Address - Country:US
Practice Address - Phone:864-559-7006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health