Healthcare Provider Details

I. General information

NPI: 1750374716
Provider Name (Legal Business Name): ERICA MICHELLE FORD PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 01/21/2022
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 S KING ST
WINDSOR NC
27983-9666
US

IV. Provider business mailing address

1403 S KING ST
WINDSOR NC
27983-9666
US

V. Phone/Fax

Practice location:
  • Phone: 252-426-5711
  • Fax: 252-426-1999
Mailing address:
  • Phone: 252-794-6775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number102796
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: