Healthcare Provider Details

I. General information

NPI: 1639335763
Provider Name (Legal Business Name): LINDA D. FORD, M.D.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 BOB ARNOLD BLVD SUITE A
LITHIA SPRINGS GA
30122-3258
US

IV. Provider business mailing address

PO BOX 1248
LITHIA SPRINGS GA
30122-1165
US

V. Phone/Fax

Practice location:
  • Phone: 770-944-9852
  • Fax: 770-944-1043
Mailing address:
  • Phone: 770-944-9852
  • Fax: 770-944-1043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number017051
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LINDA DIANNE FORD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 770-944-9852