1396892360 NPI number — MS. TAMERA NANEKE FERGUSON LCSW

Table of content: MS. TAMERA NANEKE FERGUSON LCSW (NPI 1396892360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396892360 NPI number — MS. TAMERA NANEKE FERGUSON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERGUSON
Provider First Name:
TAMERA
Provider Middle Name:
NANEKE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1396892360
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 PHILIP BLVD
Provider Second Line Business Mailing Address:
APT 710
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30046-8738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-540-6477
Provider Business Mailing Address Fax Number:
770-962-3842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 PHILIP BLVD
Provider Second Line Business Practice Location Address:
APT 710
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30046-8738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-540-6477
Provider Business Practice Location Address Fax Number:
770-962-3842
Provider Enumeration Date:
01/04/2007

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: 1041C0700X , with the licence number:  CSW004319 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041S0200X , with the licence number: 434377 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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