Provider Demographics
NPI:1881759256
Name:FERGUSON, JAMEELA (SLP)
Entity type:Individual
Prefix:MRS
First Name:JAMEELA
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 MARKETPLACE BLVD
Mailing Address - Street 2:SUITE 130-184
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5747
Mailing Address - Country:US
Mailing Address - Phone:404-245-4848
Mailing Address - Fax:770-892-4958
Practice Address - Street 1:3645 MARKETPLACE BLVD
Practice Address - Street 2:SUITE 130-184
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5747
Practice Address - Country:US
Practice Address - Phone:770-892-4878
Practice Address - Fax:770-892-4958
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
GASLP005380235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000970153AMedicaid