MEDICARE: CAREY LEE CHRISTIANSEN FORD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	23318	NE
2	207P00000X	Emergency Medicine Physician	39316	SC
3	207Q00000X	Family Medicine Physician	23318	NE

General Provider Information

NPI Number	:	1013906130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAREY LEE CHRISTIANSEN FORD MD

Provider Business Mailing Address
First Line	:	60 EXCHANGE ST STE B7
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-7646
Country	:	US
Telephone Number	:	912-756-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 EXCHANGE ST STE B7
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-7646
Country	:	US
Telephone Number	:	912-756-2273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	04/16/2025

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