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General NPI Number Information
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NPI Number | 1487801924
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Entity Type | Organization
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Legal Business Name | VALLEY IMAGING PARTNERS, P.C.
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 07/01/2009
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Provider Practice Location Address
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Address Line | 1000 HWY 28
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City | JASPER
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State | TN
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Zip | 37347
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Country | US
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Telephone | 423-591-2632
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Fax | 423-837-9549
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Provider Business Mailing Address
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Address Line | P.O. BOX 97
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City | JASPER
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State | TN
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Zip | 37347
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Country | US
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Telephone | 423-591-2632
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Fax | 423-837-9549
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDRICK JORDAN 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 | 0000026307
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD26307
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License Number State | TN
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