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General NPI Number Information
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NPI Number | 1003428574
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Entity Type | Individual
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Provider Name | MR. GREGORY RAYMON FORD JR.
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Gender | Male
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Dates
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Enumeration Date | 08/17/2020
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 5188 CARTER WAY
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-7170
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Country | US
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Telephone | 678-230-4555
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Fax |
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Provider Business Mailing Address
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Address Line | 5188 CARTER WAY
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-7170
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Country | US
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Telephone | 904-445-7228
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9480288
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN-NP334093
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License Number State | GA
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