Individual
TABITHA FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
110 SHORTER ST LOT 9, TY TY, GA 31795-3179
(229) 256-7374
Mailing address
110 SHORTER ST LOT 9, TY TY, GA 31795-3179
(229) 256-7374
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN173276
GA
Other
Enumeration date
10/16/2020
Last updated
10/16/2020
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