Provider Demographics
NPI:1659713212
Name:FORD, DEBORAH PATRICE (NP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:PATRICE
Last Name:FORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1275 SHILOH RD NW STE 2770
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7198
Mailing Address - Country:US
Mailing Address - Phone:404-426-3010
Mailing Address - Fax:
Practice Address - Street 1:1275 SHILOH RD NW STE 2770
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7198
Practice Address - Country:US
Practice Address - Phone:404-426-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009753363LP0808X
GARN111299363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily