Individual
TAILEY RENEE FERGUSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5904 LAKE SHORE DR, NAYLOR, GA 31641-2562
(662) 554-2109
(662) 554-2109
Mailing address
5904 LAKE SHORE DR, NAYLOR, GA 31641-2562
(662) 554-2109
(662) 554-2109
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
03/17/2025
Last updated
03/17/2025
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