MEDICARE: YAKEIA FORD

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	363LG0600X	Gerontology Nurse Practitioner	RN232732	GA
2	363LA2200X	Adult Health Nurse Practitioner	RN232732	GA

General Provider Information

NPI Number	:	1073145892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAKEIA FORD

Provider Business Mailing Address
First Line	:	2100 RIVEREDGE PKWY
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-4693
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 RIVEREDGE PKWY
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-4693
Country	:	US
Telephone Number	:	931-302-5985
Fax Number	:

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

Provider Enumeration Date	:	02/10/2020
Last Update Date	:	02/10/2020

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Directions to “ YAKEIA FORD ” Practice Location

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