Healthcare Provider Details

I. General information

NPI: 1700077419
Provider Name (Legal Business Name): WRENS MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BROAD ST
WRENS GA
30833-1185
US

IV. Provider business mailing address

501 BROAD ST
WRENS GA
30833-1185
US

V. Phone/Fax

Practice location:
  • Phone: 706-547-2559
  • Fax: 706-547-0729
Mailing address:
  • Phone: 706-547-2559
  • Fax: 706-547-0729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number014489
License Number StateGA

VIII. Authorized Official

Name: JAMES MILTON FORD
Title or Position: OWNER
Credential: MD
Phone: 706-547-2559