Healthcare Provider Details

I. General information

NPI: 1881361707
Provider Name (Legal Business Name): KENDRAH FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 PERIMETER CTR N APT 2031
ATLANTA GA
30346-2489
US

IV. Provider business mailing address

302 PERIMETER CTR N APT 2031
ATLANTA GA
30346-2489
US

V. Phone/Fax

Practice location:
  • Phone: 470-572-8206
  • Fax:
Mailing address:
  • Phone: 470-572-8206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN197189
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: