Doctor Name: | NICOLE FORD |
NPI Number: | 1588642771 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP-C |
License Number: | RN139406 |
Business Practice Address: | 11973 Augusta Rd Lavonia, GA - 305531283 |
Business Phone Number: | 7063568181 |
Business Fax Number: | 7063568081 |
Mailing Address: | 172 Tanglewood S, ROYSTON |
State: | GA |
Postal Code: | 306623799 |
Phone Number: | 7062459168 |
Fax Number: | |
NPI Enumeration Date: | 01/06/2006 |
NPI Last Update Date: | 03/04/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN139406 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |