Provider Demographics
NPI:1558369462
Name:FORD, ALBERT SHEDERICK JR (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:SHEDERICK
Last Name:FORD
Suffix:JR
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 1:1509 DULLES DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506
Mailing Address - Country:US
Mailing Address - Phone:337-991-9276
Mailing Address - Fax:337-943-0846
Practice Address - Street 1:132 HOMESTEAD FARM CIR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-8208
Practice Address - Country:US
Practice Address - Phone:828-687-8670
Practice Address - Fax:828-687-6293
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300699207RG0300X
SC37441207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8932996Medicaid
NC32996OtherBCBS
NC380001071OtherMEDICARE RAILROAD
NC32996OtherBCBS
NC8932996Medicaid