Provider Demographics
NPI:1174327357
Name:FORD, JENNIFER YVONNE (NP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:YVONNE
Last Name:FORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:YVONNE
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:101 MIRROR LAKE BLVD,
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180
Mailing Address - Country:US
Mailing Address - Phone:770-812-0445
Mailing Address - Fax:770-945-7500
Practice Address - Street 1:101 QUARTZ DR STE 101
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-3256
Practice Address - Country:US
Practice Address - Phone:770-812-0445
Practice Address - Fax:770-942-8800
Is Sole Proprietor?:No
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN137808207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine