Individual
WILSON FERGUSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
1418 TIGER DR, THIBODAUX, LA 70301-4337
(985) 449-4055
(985) 449-4178
Mailing address
1418 TIGER DR, THIBODAUX, LA 70301-4337
(985) 449-4055
(985) 449-4178
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
172A00000X
Driver
Primary
009497183
LA
Other
Enumeration date
06/12/2023
Last updated
08/03/2023
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