Provider Demographics
NPI:1861502338
Name:FORD, LINDA DIANNE (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:DIANNE
Last Name:FORD
Suffix:
Gender:F
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: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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017051207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00531946AMedicaid
GA0468089OtherAETNA
GA239704OtherBLUE CROSS BLUE SHIELD
GA7406929OtherUNITED HEALTHCARE
GAD39873Medicare UPIN