Mitzi Ferguson, MD, LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

09298 Issued in MS

Legal business name

MITZI FERGUSON, MD, LLC

Practice address

4500 I 55 N
Suite 215
Jackson, MS 39211-5930

Phone

(601) 212-0955

NPI assigned

Oct 25, 2011

Last updated

Oct 25, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Susan C. Kerley

Title

Credentialing/Billing Specialist

Phone

(601) 957-7340

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1319500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319500800000",
    "number": "1952687717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1990 PETIT BOIS ST N",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392116707",
            "telephone_number": "601-957-7344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 I 55 N",
            "address_2": "SUITE 215",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392115930",
            "telephone_number": "601-212-0955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MITZI FERGUSON, MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-25",
        "last_updated": "2011-10-25",
        "status": "A",
        "authorized_official_last_name": "KERLEY",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "CREDENTIALING/BILLING SPECIALIST",
        "authorized_official_telephone_number": "601-957-7340"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "MS",
            "license": "09298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Skyla D Mitchell
• Stacey M Mitchell, PCMHT
• Summer Mitchell, FNP-BC
• Sydney Caroline Mitchell
• Victoria Mitchell, NNP-BC
• Susan Pee Mixon, NPC
• Elizabeth Kaitlyn Mize, M.D.
• Tiffany Mizner, MD
• John P Mladineo, M.D.
• Joseph Samuel Moak Jr., MD

• General Practice Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• General Practice Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2011; 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.