Healthcare Provider Details

I. General information

NPI: 1245241892
Provider Name (Legal Business Name): DENNIS CLIFFORD FORD MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 KEITH ST NW STE C
CLEVELAND TN
37311-1351
US

IV. Provider business mailing address

2020 KEITH ST NW STE C
CLEVELAND TN
37311-1351
US

V. Phone/Fax

Practice location:
  • Phone: 423-614-0535
  • Fax: 423-614-0545
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number012143
License Number StateTN

VIII. Authorized Official

Name: SARAH BETH FORD
Title or Position: OFFICE MANAGER
Credential:
Phone: 423-614-0535