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General NPI Number Information
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NPI Number | 1811273899
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Entity Type | Individual
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Provider Name | DIANA GAIL FORD O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/23/2011
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Last Update Date | 07/01/2022
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Provider Practice Location Address
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Address Line | 1550 RIVERSTONE PKWY
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City | CANTON
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State | GA
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Zip | 30114-2918
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Country | US
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Telephone | 770-720-1023
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Fax |
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Provider Business Mailing Address
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Address Line | 108 LINKSIDE CT
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City | WOODSTOCK
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State | GA
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Zip | 30189-2515
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Country | US
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Telephone | 770-557-5869
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2635
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License Number State | GA
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