Individual
MARY FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2 MEDICAL PARK RD STE 506, COLUMBIA, SC 29203-6876
(803) 434-3560
(803) 545-5303
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/13/2020
Last updated
10/04/2021
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