Healthcare Provider Details

I. General information

NPI: 1235027574
Provider Name (Legal Business Name): EMILY FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4490 WASHINGTON RD STE 14
EVANS GA
30809-5898
US

IV. Provider business mailing address

1212 AUGUSTA WEST PKWY STE 1B
AUGUSTA GA
30909-1808
US

V. Phone/Fax

Practice location:
  • Phone: 706-250-0022
  • Fax:
Mailing address:
  • Phone: 706-826-2770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: