Healthcare Provider Details

I. General information

NPI: 1275266645
Provider Name (Legal Business Name): KRISTY LEDFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 MIKE PADGETT HWY
AUGUSTA GA
30906-3815
US

IV. Provider business mailing address

1916 PRESERVATION CIR
EVANS GA
30809-0687
US

V. Phone/Fax

Practice location:
  • Phone: 706-432-4837
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number015740
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: