Provider Demographics
NPI:1720385206
Name:FORD, CHERYL S
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:S
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 JAYNE LEWIS CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-0962
Mailing Address - Country:US
Mailing Address - Phone:901-828-2670
Mailing Address - Fax:901-379-3530
Practice Address - Street 1:4745 POPLAR AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4430
Practice Address - Country:US
Practice Address - Phone:901-864-4637
Practice Address - Fax:901-379-3530
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN55698333172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver