Provider Demographics
NPI:1770541518
Name:FERGUSON, ELLEN M (DO)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:M
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3163 TUCKER NORCROSS RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-2124
Mailing Address - Country:US
Mailing Address - Phone:770-939-6000
Mailing Address - Fax:770-491-9195
Practice Address - Street 1:3163 TUCKER NORCROSS RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-2124
Practice Address - Country:US
Practice Address - Phone:770-939-6000
Practice Address - Fax:770-491-9195
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2008-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA050162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH09172Medicare UPIN
GA511I080181Medicare PIN