Individual
DEANANNE D FORDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
109 S 3RD ST, COCHRAN, GA 31014-6718
(478) 934-4988
(478) 934-4989
Mailing address
109 S 3RD ST, COCHRAN, GA 31014-6718
(478) 934-4988
(478) 934-4989
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
003393
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100001203A
—
GA
Enumeration date
03/07/2006
Last updated
01/14/2026
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