MEDICARE: MR. CHARLES FERGUSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	I000000035463	TN

General Provider Information

NPI Number	:	1508605189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES FERGUSON

Provider Business Mailing Address
First Line	:	5871 MEMPHIS ARLINGTON RD
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38135-2333
Country	:	US
Telephone Number	:	901-440-5479
Fax Number	:

Provider Business Practice Location Address
First Line	:	5871 MEMPHIS ARLINGTON RD
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38135-2333
Country	:	US
Telephone Number	:	901-440-5479
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2024
Last Update Date	:	05/22/2024

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Directions to “ MR. CHARLES FERGUSON ” Practice Location

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