Healthcare Provider Details

I. General information

NPI: 1821887613
Provider Name (Legal Business Name): DEBRA M FORD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 06/15/2025
Certification Date: 06/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3776 WESTCHASE DR
MARIETTA GA
30066-2580
US

IV. Provider business mailing address

3776 WESTCHASE DR
MARIETTA GA
30066-2580
US

V. Phone/Fax

Practice location:
  • Phone: 706-513-0158
  • Fax:
Mailing address:
  • Phone: 706-513-0158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number129135
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN129135
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number129135
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number129135
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number129135
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number129135
License Number StateGA
# 7
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number129135
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: