MEDICARE: NORLISHIA L FORD

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
1	163W00000X	Registered Nurse	RN9473714	FL

General Provider Information

NPI Number	:	1952913436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NORLISHIA L FORD

Provider Business Mailing Address
First Line	:	5188 CARTER WAY
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30135-7170
Country	:	US
Telephone Number	:	904-445-9711
Fax Number	:

Provider Business Practice Location Address
First Line	:	2702 SCHAUL ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-2123
Country	:	US
Telephone Number	:	706-641-2441
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2020
Last Update Date	:	08/17/2020

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