Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN195415 | GA |
NPI | 1043734452 |
---|---|
Provider Name | Erin Ferguson |
First Address | Acworth, GA 30101-4020 |
Second Address | Smyrna, GA 30080-6906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2017 |
Last Update Date | 27/07/2017 |