Healthcare Provider Details

I. General information

NPI: 1962579102
Provider Name (Legal Business Name): JOHN TILLMAN WARD LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/02/2023
Certification Date: 07/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

826 FORREST CIR SE
ATLANTA GA
30354-2538
US

V. Phone/Fax

Practice location:
  • Phone: 404-489-2008
  • Fax:
Mailing address:
  • Phone: 404-449-8027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberLPC009903
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: