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General NPI Number Information
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NPI Number | 1518962968
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Entity Type | Individual
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Provider Name | CLAY WALT FERGUSON MD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 114 N MAIN ST
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City | NASHVILLE
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State | AR
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Zip | 71852-2001
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Country | US
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Telephone | 870-845-0033
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Fax | 870-451-9878
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Provider Business Mailing Address
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Address Line | PO BOX 522
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City | NASHVILLE
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State | AR
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Zip | 71852-0522
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Country | US
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Telephone | 870-845-0033
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Fax | 870-451-9878
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | C8428
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD0000031428
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License Number State | TN
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