Organization
ATLANTIC NEPHROLOGY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM BONLORE FERGUSON MD, PHD (PRESIDENT/OWNER)
(386) 871-3767
Entity
Organization
Contact information
Practice address
210 OLD KINGS RD S STE 900, FLAGLER BEACH, FL 32136-4380
(383) 338-3550
(386) 338-3551
Mailing address
210 OLD KINGS RD S STE 900, FLAGLER BEACH, FL 32136-4380
(386) 338-3550
(386) 338-3551
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
ME94793
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000159300
—
FL
05
—
250792700
—
FL
01
—
40336
MEDICARE NUMBER
FL
01
—
AD824Z
PTAN
FL
Enumeration date
06/24/2008
Last updated
09/15/2025
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