Provider Demographics
NPI:1912923905
Name:FORD, MILLICENT BOOKER (MD)
Entity Type:Individual
Prefix:DR
First Name:MILLICENT
Middle Name:BOOKER
Last Name:FORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MILLICENT
Other - Middle Name:CANDENE
Other - Last Name:BOOKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1701 WESTCHESTER DR STE 850
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-702-2007
Mailing Address - Fax:
Practice Address - Street 1:2933 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4001
Practice Address - Country:US
Practice Address - Phone:336-794-3380
Practice Address - Fax:336-794-3378
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401028208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89138AXMedicaid
NC89138AXMedicaid