Organization
MITZI FERGUSON, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN C. KERLEY (CREDENTIALING/BILLING SPECIALIST)
(601) 957-7340
Entity
Organization
Contact information
Practice address
4500 I 55 N, SUITE 215, JACKSON, MS 39211-5930
(601) 212-0955
Mailing address
1990 PETIT BOIS ST N, JACKSON, MS 39211-6707
(601) 957-7344
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
09298
MS
Other
Enumeration date
10/25/2011
Last updated
10/25/2011
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