Healthcare Provider Details

I. General information

NPI: 1013629765
Provider Name (Legal Business Name): CAMIRA FERGUSON APC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 COURTENAY DR NE
ATLANTA GA
30306-3421
US

IV. Provider business mailing address

4456 OAKLEAF CV
DECATUR GA
30034-6246
US

V. Phone/Fax

Practice location:
  • Phone: 404-875-4551
  • Fax: 404-892-1770
Mailing address:
  • Phone: 309-750-0503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC008770
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: