Individual provider Active NPI

Tamera Naneke Ferguson, LCSW

  • Clinical Social Worker
  • Lawrenceville, GA
National Provider Identifier
1396892360
Registry record updated Dec 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW004319 Issued in GA
Practice address
405 Philip Blvd
Apt 710
Lawrenceville, GA 30046-8738
Phone
(706) 540-6477
Fax
(770) 962-3842
NPI assigned
Jan 4, 2007
Last updated
Dec 1, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X CSW004319 GA Primary
School Social Worker 1041S0200X 434377 GA

Addresses

Primary practice location

405 Philip Blvd
Apt 710
Lawrenceville, GA 30046-8738

Mailing address

405 Philip Blvd
Apt 710
Lawrenceville, GA 30046-8738
Phone (706) 540-6477

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CSW004319GAMDClinical Social Worker
434377GAMDSchool Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291161600000",
    "number": "1396892360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 PHILIP BLVD",
            "address_2": "APT 710",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468738",
            "telephone_number": "706-540-6477",
            "fax_number": "770-962-3842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 PHILIP BLVD",
            "address_2": "APT 710",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468738",
            "telephone_number": "706-540-6477",
            "fax_number": "770-962-3842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERGUSON",
        "first_name": "TAMERA",
        "middle_name": "NANEKE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2010-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW004319",
            "primary": true
        },
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "GA",
            "license": "434377",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.