MEDICARE: DR. JAMES DAVID FERGUSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	22985	OK
2	207V00000X	Obstetrics & Gynecology Physician	34096	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	AA7941	OTHER	SC	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205892536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES DAVID FERGUSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 402145
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-2145
Country	:	US
Telephone Number	:	803-296-7305
Fax Number	:	803-296-7330

Provider Business Practice Location Address
First Line	:	1301 TAYLOR ST
Second Line	:	STE 7B
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2942
Country	:	US
Telephone Number	:	803-254-9461
Fax Number	:	803-254-9318

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	03/07/2014

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Directions to “ DR. JAMES DAVID FERGUSON M.D.” Practice Location

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