Provider Demographics
NPI:1639335763
Name:LINDA D. FORD, M.D.P.C.
Entity Type:Organization
Organization Name:LINDA D. FORD, M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-944-9852
Mailing Address - Street 1:PO BOX 1248
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-1165
Mailing Address - Country:US
Mailing Address - Phone:770-944-9852
Mailing Address - Fax:770-944-1043
Practice Address - Street 1:939 BOB ARNOLD BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-3258
Practice Address - Country:US
Practice Address - Phone:770-944-9852
Practice Address - Fax:770-944-1043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017051207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD39873Medicare UPIN