Healthcare Provider Details

I. General information

NPI: 1861560021
Provider Name (Legal Business Name): DAWN CAMILLE FERGUSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 WHITE INGRAM PKWY
DALLAS GA
30132-0969
US

IV. Provider business mailing address

1096 FOX ST SE
CONYERS GA
30013-2942
US

V. Phone/Fax

Practice location:
  • Phone: 678-647-9947
  • Fax: 678-363-7787
Mailing address:
  • Phone: 770-634-6332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number035179
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number035179
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: