MEDICARE: LINDA DIANNE FORD M.D.

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	207VG0400X	Gynecology Physician	017051	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0468089	OTHER	GA	AETNA
3	239704	OTHER	GA	BLUE CROSS BLUE SHIELD
4	7406929	OTHER	GA	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1861502338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA DIANNE FORD M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1248
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-1165
Country	:	US
Telephone Number	:	770-944-9852
Fax Number	:	770-944-1043

Provider Business Practice Location Address
First Line	:	939 BOB ARNOLD BLVD
Second Line	:	SUITE A
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-3258
Country	:	US
Telephone Number	:	770-944-9852
Fax Number	:	770-944-1043

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/29/2008

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Directions to “ LINDA DIANNE FORD M.D.” Practice Location

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