Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 27065 | AL |
Y | 2080P0202X | Pediatric Cardiologist | 064785 | GA |
NPI | 1124233606 |
---|---|
Provider Name | Matthew Eric Ferguson |
First Address | Atlanta, GA 30341-5540 |
Second Address | Atlanta, GA 30322-5540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 22/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
743167000 | (05) | MN |