Individual provider Active NPI

Shawn Pomy Ferguson

  • Chiropractor
  • Woodstock, GA
National Provider Identifier
1295870947
Registry record updated Apr 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
6631 Issued in GA
Practice address
2453 Towne Lake Parkway
Woodstock, GA 30189-2836
Phone
(770) 592-2505
Fax
(770) 592-2433
NPI assigned
Feb 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 6631 GA Primary

Addresses

Primary practice location

2453 Towne Lake Parkway
Woodstock, GA 30189-2836

Mailing address

2453 Towne Lake Parkway
Woodstock, GA 30189-2836
Phone (770) 592-2505

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160420000363 GA Practitioner - Chiropractic 9133427487 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2000
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2453 Towne Lake Pkwy
Woodstock, GA 30189-5525
Phone (770) 592-2505

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6631GAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Law of Attraction LLC Chiropractor CurrentSince Feb 9, 2016 Accepting new patients

Locations

2453 Towne Lake Pkwy
Woodstock, GA 30189
Phone (770) 592-2504

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461024000000",
    "number": "1295870947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2453 TOWNE LAKE PARKWAY",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301892836",
            "telephone_number": "770-592-2505",
            "fax_number": "770-592-2433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2453 TOWNE LAKE PARKWAY",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301892836",
            "telephone_number": "770-592-2505",
            "fax_number": "770-592-2433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERGUSON",
        "first_name": "SHAWN",
        "middle_name": "POMY",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-20",
        "last_updated": "2016-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "6631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodstock, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.