Provider Demographics
NPI:1417334285
Name:FORD, SYDNE DANIELLE (MD)
Entity Type:Individual
Prefix:
First Name:SYDNE
Middle Name:DANIELLE
Last Name:FORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4791 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-5324
Mailing Address - Country:US
Mailing Address - Phone:404-251-1600
Mailing Address - Fax:
Practice Address - Street 1:4791 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5324
Practice Address - Country:US
Practice Address - Phone:404-251-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54857207Q00000X
AZR74970207Q00000X
GA80730207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine