Healthcare Provider Details

I. General information

NPI: 1508495268
Provider Name (Legal Business Name): SHOWANNA L FERGUSON BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2020
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

4681 MEADOWS RD
POWDER SPRINGS GA
30127-3147
US

V. Phone/Fax

Practice location:
  • Phone: 470-788-1010
  • Fax:
Mailing address:
  • Phone: 813-394-7416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9416572
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95156877
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberGAA-NP000413
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberGAA-NP000413
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: