Provider Demographics
NPI:1124006200
Name:FORD, WILLIAM CHESTER JR (NP-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CHESTER
Last Name:FORD
Suffix:JR
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 TANGLEWOOD S
Mailing Address - Street 2:
Mailing Address - City:ROYSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30662-3799
Mailing Address - Country:US
Mailing Address - Phone:706-356-8181
Mailing Address - Fax:
Practice Address - Street 1:11973 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:LAVONIA
Practice Address - State:GA
Practice Address - Zip Code:30553-1283
Practice Address - Country:US
Practice Address - Phone:706-356-8181
Practice Address - Fax:706-356-8081
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN144697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA346968043AMedicaid
GA346968043AMedicaid
GAQ23994Medicare UPIN