Individual
MRS. DEBORAH WARE FORDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1826 VETERANS BOULEVARD, CARL VINSON VA MEDICAL CENTER, DUBLIN, GA 31021
(478) 272-1210
Mailing address
RR 1 BOX 60-1, 1127 REBIE ROAD, CHESTER, GA 31012-9538
(478) 358-4370
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
002877
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002877
PA-C NUMBER
GA
01
—
1032004
NATIONAL NCCPA NUMBER
—
Enumeration date
10/17/2006
Last updated
07/09/2007
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