Healthcare Provider Details

I. General information

NPI: 1366476814
Provider Name (Legal Business Name): JEFFREY ROBERT WARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JEFFREY R WARD M.D.

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/08/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 JESSE JEWELL PARKWAY SUITE 200
GAINESVILLE GA
30501
US

IV. Provider business mailing address

PO BOX 742616
ATLANTA GA
30374-2616
US

V. Phone/Fax

Practice location:
  • Phone: 770-219-9300
  • Fax:
Mailing address:
  • Phone: 770-219-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number042136
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: