Individual
MR. JASON FORDYCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
307 OLD STONE RD, VILLA RICA, GA 30180-1214
(770) 459-8799
Mailing address
307 OLD STONE RD, VILLA RICA, GA 30180-1214
(770) 459-8799
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN223272
GA
Other
Enumeration date
06/03/2021
Last updated
07/08/2021
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