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General NPI Number Information
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NPI Number | 1174951271
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Entity Type | Organization
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Legal Business Name | VALLEY MEDICAL IMAGING
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 1000 HIGHWAY 28
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City | JASPER
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State | TN
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Zip | 37347-3638
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Country | US
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Telephone | 423-591-2632
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 97
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City | JASPER
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State | TN
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Zip | 37347-3638
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Country | US
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Telephone | 423-591-2632
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDRICK FERGUSON
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Credential | MD
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Telephone | 423-591-2632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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