Healthcare Provider Details

I. General information

NPI: 1205900552
Provider Name (Legal Business Name): CORY JOHN FERGUSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 N MAIN ST
ADAIRSVILLE GA
30103-2438
US

IV. Provider business mailing address

323 N MAIN ST
ADAIRSVILLE GA
30103-2438
US

V. Phone/Fax

Practice location:
  • Phone: 770-773-1997
  • Fax: 770-773-9995
Mailing address:
  • Phone: 770-773-9997
  • Fax: 770-773-9995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6873
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: