Healthcare Provider Details

I. General information

NPI: 1790177350
Provider Name (Legal Business Name): FORD PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6341 PICCADILLY SQUARE DR
MOBILE AL
36609-5103
US

IV. Provider business mailing address

5701 OAKLEIGH TRACE CT
MOBILE AL
36693-3076
US

V. Phone/Fax

Practice location:
  • Phone: 251-343-5300
  • Fax:
Mailing address:
  • Phone: 513-200-5110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number33371
License Number StateAL

VIII. Authorized Official

Name: DR. LISA DANITA FORD-CRAWFORD
Title or Position: OWNER
Credential: MD
Phone: 513-200-5110