Provider Demographics
NPI:1821681388
Name:WARD, ANDERSON JAY III (CCP)
Entity type:Individual
Prefix:MR
First Name:ANDERSON
Middle Name:JAY
Last Name:WARD
Suffix:III
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 COPPERLEAF WALK
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-6510
Mailing Address - Country:US
Mailing Address - Phone:209-985-1777
Mailing Address - Fax:
Practice Address - Street 1:565 COPPERLEAF WALK
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-6510
Practice Address - Country:US
Practice Address - Phone:209-985-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
229193242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionistGroup - Single Specialty