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TRACY FERGUSON M.D.
>> Pediatrics >> Allopathic & Osteopathic PhysiciansRegistrant NPI Number: 1922063734
Individual Registrant: TRACY FERGUSON M.D.
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
4112 E PONCE DE LEON AVE CLARKSTON, GA 30021-8106 US
Tel: 404-296-7133 Fax: 404-296-7211
Tel: 404-296-7133 Fax: 404-296-7211
Contact information for business:
4112 E PONCE DE LEON AVE CLARKSTON, GA 30021-8106 US
Tel: 404-296-7133 Fax: 404-296-7211
Tel: 404-296-7133 Fax: 404-296-7211
Registration Information:
NPI: 1922063734
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 208000000X | Allopathic & Osteopathic Physicians Pediatrics | GA | 054023 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 347582150A | GA | 05 | |
| 347582150B | GA | 05 |
