Individual
MISS DAWN CAMILLE FERGUSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
311 WHITE INGRAM PKWY, DALLAS, GA 30132-0969
(678) 647-9947
(678) 363-7787
Mailing address
1096 FOX ST SE, CONYERS, GA 30013-2942
(770) 634-6332
Taxonomy
Speciality
Code
Description
License number
State
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
035179
GA
225400000X
Rehabilitation Practitioner
Primary
035179
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000616932E
—
GA
Enumeration date
12/04/2006
Last updated
01/08/2025
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