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General NPI Number Information
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NPI Number | 1003057696
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Entity Type | Organization
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Legal Business Name | EASTERN CAROLINA GERIATRIC ASSOCIATES AND FAMILY CARE CENTER PLLC
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 105 COMMERCE STREET
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City | POWELLSVILLE
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State | NC
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Zip | 27967-0040
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Country | US
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Telephone | 252-332-6484
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Fax | 252-332-1660
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Provider Business Mailing Address
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Address Line | 105 COMMERCE STREET PO BOX 40
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City | POWELLSVILLE
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State | NC
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Zip | 27967
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Country | US
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Telephone | 252-332-6484
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Fax | 252-332-1660
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN WALLACE FERGUSON
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Credential | M.D.
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Telephone | 252-332-6484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 36700
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License Number State | NC
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