Provider Demographics
NPI:1386687275
Name:FORD, JANICE E (NP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:E
Last Name:FORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:31329
Mailing Address - Country:US
Mailing Address - Phone:912-754-1035
Mailing Address - Fax:912-754-1037
Practice Address - Street 1:1451 HIGHWAY 21 SOUTH
Practice Address - Street 2:SUITE H
Practice Address - City:SPRINGFIELD
Practice Address - State:GA
Practice Address - Zip Code:31329
Practice Address - Country:US
Practice Address - Phone:912-754-1035
Practice Address - Fax:912-754-1037
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN057176363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000483788HMedicaid
GA000483788HMedicaid