1437266285 NPI number — DR. MARTA JILL FERGUSON D.O.

Table of content: DR. MARTA JILL FERGUSON D.O. (NPI 1437266285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437266285 NPI number — DR. MARTA JILL FERGUSON D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERGUSON
Provider First Name:
MARTA
Provider Middle Name:
JILL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437266285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2910 HIGHWAY 115 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30528-4448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-219-3298
Provider Business Mailing Address Fax Number:
706-219-3298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNION GENERAL HOSPITAL
Provider Second Line Business Practice Location Address:
214 HOSPITAL CIR
Provider Business Practice Location Address City Name:
BLAIRSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30512-9221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-745-2111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  038422 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)