Healthcare Provider Details

I. General information

NPI: 1740272707
Provider Name (Legal Business Name): FATIMA ASTACIO-FORD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 E LAMAR ST STE 2
AMERICUS GA
31709-3781
US

IV. Provider business mailing address

1102 E LAMAR ST STE 2
AMERICUS GA
31709-3781
US

V. Phone/Fax

Practice location:
  • Phone: 229-514-1444
  • Fax: 229-514-1422
Mailing address:
  • Phone: 229-514-1444
  • Fax: 229-514-1422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number46351
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: