Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 076588 | GA |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 076588 | GA |
NPI | 1194081422 |
---|---|
Provider Name | Dr. Alexcis Thomson Ford |
First Address | Snellville, GA 30078-5639 |
Second Address | Roswell, GA 30076-4916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2012 |
Last Update Date | 19/09/2019 |