Provider Demographics
NPI:1679192462
Name:FORD, ARIES (RDN,LDN)
Entity Type:Individual
Prefix:
First Name:ARIES
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:RDN,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 MICA CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6461
Mailing Address - Country:US
Mailing Address - Phone:716-572-9803
Mailing Address - Fax:
Practice Address - Street 1:442 MICA CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6461
Practice Address - Country:US
Practice Address - Phone:716-572-9803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-11
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002022133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty