Provider Demographics
NPI:1700077419
Name:WRENS MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:WRENS MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-547-2559
Mailing Address - Street 1:501 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WRENS
Mailing Address - State:GA
Mailing Address - Zip Code:30833-1185
Mailing Address - Country:US
Mailing Address - Phone:706-547-2559
Mailing Address - Fax:706-547-0729
Practice Address - Street 1:501 BROAD ST
Practice Address - Street 2:
Practice Address - City:WRENS
Practice Address - State:GA
Practice Address - Zip Code:30833-1185
Practice Address - Country:US
Practice Address - Phone:706-547-2559
Practice Address - Fax:706-547-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2627Medicare PIN