Healthcare Provider Details

I. General information

NPI: 1851255269
Provider Name (Legal Business Name): CHARLES ALVIN FORD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4849 CAMPBELL RD
ASHVILLE OH
43103-9786
US

IV. Provider business mailing address

4849 CAMPBELL RD
ASHVILLE OH
43103-9786
US

V. Phone/Fax

Practice location:
  • Phone: 740-601-7524
  • Fax:
Mailing address:
  • Phone: 740-601-7524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberAPS006760
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: