Provider Demographics
NPI:1063723757
Name:FERGUSON POWELL, DAVIDA EDITH
Entity type:Individual
Prefix:MRS
First Name:DAVIDA
Middle Name:EDITH
Last Name:FERGUSON POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DAVIDA
Other - Middle Name:EDITH
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:181 COUNTY SHED RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-8765
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:181 COUNTY SHED RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-8765
Practice Address - Country:US
Practice Address - Phone:843-310-9542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101329163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse