Provider Demographics
NPI:1033117684
Name:FORD, JAMES MILTON (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MILTON
Last Name:FORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WRENS
Mailing Address - State:GA
Mailing Address - Zip Code:30833-1185
Mailing Address - Country:US
Mailing Address - Phone:706-547-2559
Mailing Address - Fax:706-547-0729
Practice Address - Street 1:501 BROAD ST
Practice Address - Street 2:
Practice Address - City:WRENS
Practice Address - State:GA
Practice Address - Zip Code:30833-1185
Practice Address - Country:US
Practice Address - Phone:706-547-2559
Practice Address - Fax:706-547-0729
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00189945AMedicaid
GAGRP2627Medicare ID - Type Unspecified
GAD45360Medicare UPIN