Individual
TRACY FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4112 E PONCE DE LEON AVE, CLARKSTON, GA 30021-8106
(404) 296-7133
(404) 296-7211
Mailing address
4112 E PONCE DE LEON AVE, CLARKSTON, GA 30021-8106
(404) 296-7133
(404) 296-7211
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
054023
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
347582150A
—
GA
05
—
347582150B
—
GA
Enumeration date
04/18/2006
Last updated
01/13/2022
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