Provider Demographics
NPI:1699978106
Name:FERGUSON, ANGEL (MS)
Entity type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 MAIN ST W
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3149
Mailing Address - Country:US
Mailing Address - Phone:866-770-7294
Mailing Address - Fax:866-770-7294
Practice Address - Street 1:2821 MAIN ST W
Practice Address - Street 2:SUITE 6
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3149
Practice Address - Country:US
Practice Address - Phone:866-770-7294
Practice Address - Fax:866-770-7294
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006184235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA216118118EMedicaid