Provider Demographics
NPI:1740029719
Name:FORD, JESSICA ERIN
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ERIN
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 1:370 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29672-9444
Mailing Address - Country:US
Mailing Address - Phone:864-571-9622
Mailing Address - Fax:
Practice Address - Street 1:370 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-9444
Practice Address - Country:US
Practice Address - Phone:864-571-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator