Healthcare Provider Details

I. General information

NPI: 1164411963
Provider Name (Legal Business Name): ANDREW HUNTER FORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 OLIVE ST
MONTGOMERY AL
36106
US

IV. Provider business mailing address

1722 PINE ST STE 503
MONTGOMERY AL
36106-1160
US

V. Phone/Fax

Practice location:
  • Phone: 334-834-7221
  • Fax: 334-241-9848
Mailing address:
  • Phone: 334-293-8736
  • Fax: 334-293-8738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD31430
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD.37387
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: