Individual
LANICE ELAINE FERGUSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1238 VIENNA CT, HAMPTON, GA 30228-6452
(404) 797-4495
Mailing address
270 CARPENTER DR STE 400, ATLANTA, GA 30328-4933
(678) 460-0345
(678) 460-0350
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
APC006278
GA
Other
Enumeration date
01/09/2019
Last updated
01/09/2019
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