Healthcare Provider Details

I. General information

NPI: 1003057696
Provider Name (Legal Business Name): EASTERN CAROLINA GERIATRIC ASSOCIATES AND FAMILY CARE CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 COMMERCE STREET
POWELLSVILLE NC
27967-0040
US

IV. Provider business mailing address

105 COMMERCE STREET PO BOX 40
POWELLSVILLE NC
27967
US

V. Phone/Fax

Practice location:
  • Phone: 252-332-6484
  • Fax: 252-332-1660
Mailing address:
  • Phone: 252-332-6484
  • Fax: 252-332-1660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36700
License Number StateNC

VIII. Authorized Official

Name: DR. STEVEN WALLACE FERGUSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 252-332-6484