| Doctor Name: | BALEIGH FORD |
| NPI Number: | 1114387123 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | PA00275 |
| Business Practice Address: | 2080 S Frontage Rd #100 Vicksburg, MS - 391805328 |
| Business Phone Number: | 6012621000 |
| Business Fax Number: | |
| Mailing Address: | 499 Springridge Rd, Lot B1 CLINTON |
| State: | MS |
| Postal Code: | 390565600 |
| Phone Number: | 6013190685 |
| Fax Number: | |
| NPI Enumeration Date: | 03/03/2016 |
| NPI Last Update Date: | 03/03/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA00275 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |