=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174327357
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER YVONNE FORD NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2025
-----------------------------------------------------
Last Update Date | 10/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 QUARTZ DR STE 101
-----------------------------------------------------
City | VILLA RICA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30180-3256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-812-0445
-----------------------------------------------------
Fax | 770-942-8800
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 QUARTZ DR STE 101
-----------------------------------------------------
City | VILLA RICA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30180-3256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-836-9445
-----------------------------------------------------
Fax | 770-836-8808
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN-NP137808
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------