Organization
DEAN FORDHAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIFFANY T BYRD MD (MEDICAL DIRECTOR)
(706) 442-1983
Entity
Organization
Contact information
Practice address
6886 SHADYBROOK TRL, COLUMBUS, GA 31904-3802
(706) 682-0422
Mailing address
6886 SHADYBROOK TRL, COLUMBUS, GA 31904-3802
(706) 682-0422
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
56623
GA
Other
Enumeration date
04/24/2017
Last updated
04/24/2017
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