Healthcare Provider Details

I. General information

NPI: 1013832948
Provider Name (Legal Business Name): CONNIE FERGUSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9434 S MAIN ST STE 1100
JONESBORO GA
30236-6092
US

IV. Provider business mailing address

9434 S MAIN ST STE 1100
JONESBORO GA
30236-6092
US

V. Phone/Fax

Practice location:
  • Phone: 770-478-1300
  • Fax: 770-752-2161
Mailing address:
  • Phone: 770-478-1300
  • Fax: 770-752-2161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT001788
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: