Individual
MS. IRIS DENISE FORDHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
950 LANEY WALKER BLVD, AUGUSTA, GA 30901-2960
(706) 721-5931
Mailing address
950 LANEY WALKER BLVD, AUGUSTA, GA 30901-2960
(706) 721-5931
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN040000
GA
Other
Enumeration date
08/28/2007
Last updated
08/28/2007
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