Healthcare Provider Details

I. General information

NPI: 1437595634
Provider Name (Legal Business Name): BRITNAY ALEXANDRA FERGUSON PA-C, MMSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR. DRIVE, SE PO BOX 26086
ATLANTA GA
30303-0001
US

IV. Provider business mailing address

650 DELMAR AVE SE
ATLANTA GA
30312-3646
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-1000
  • Fax:
Mailing address:
  • Phone: 404-990-0545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6779
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number6779
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: