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NPI Code Detail

MEDICARE: DR. DIANA GAIL FORD O.D.

MEDICARE: DR. DIANA GAIL FORD O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist2635GA

General Provider Information

NPI Number : 1811273899
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIANA GAIL FORD O.D.
Provider Business Mailing Address
First Line : 108 LINKSIDE CT
Second Line :
City : WOODSTOCK
State : GA
Zip : 30189-2515
Country : US
Telephone Number : 770-557-5869
Fax Number :
Provider Business Practice Location Address
First Line : 1550 RIVERSTONE PKWY
Second Line :
City : CANTON
State : GA
Zip : 30114-2918
Country : US
Telephone Number : 770-720-1023
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2011
Last Update Date : 07/01/2022

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