Healthcare Provider Details

I. General information

NPI: 1407317589
Provider Name (Legal Business Name): SALACIA FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 MANCHESTER EXPY STE A
COLUMBUS GA
31904-6444
US

IV. Provider business mailing address

506 MANCHESTER EXPY STE A
COLUMBUS GA
31904-6444
US

V. Phone/Fax

Practice location:
  • Phone: 706-653-9343
  • Fax: 706-653-9242
Mailing address:
  • Phone: 706-653-9343
  • Fax: 706-653-9242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: