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General NPI Number Information
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NPI Number | 1376704155
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Entity Type | Organization
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Legal Business Name | ATLANTIC NEPHROLOGY INC
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Dates
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Enumeration Date | 06/24/2008
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 210 OLD KINGS RD S STE 900
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City | FLAGLER BEACH
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State | FL
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Zip | 32136-4380
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Country | US
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Telephone | 383-338-3550
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Fax | 386-338-3551
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Provider Business Mailing Address
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Address Line | 210 OLD KINGS RD S STE 900
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City | FLAGLER BEACH
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State | FL
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Zip | 32136-4380
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Country | US
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Telephone | 386-338-3550
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Fax | 386-338-3551
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. WILLIAM BONLORE FERGUSON
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Credential | MD, PHD
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Telephone | 386-871-3767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | ME94793
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License Number State | FL
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