Provider Demographics
NPI:1730246836
Name:FORD, MARSHA DENISE (CNM)
Entity type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:DENISE
Last Name:FORD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1310 ELVA DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-7326
Mailing Address - Country:US
Mailing Address - Phone:404-349-2112
Mailing Address - Fax:404-767-6533
Practice Address - Street 1:2719 FELTON DR STE A
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3603
Practice Address - Country:US
Practice Address - Phone:404-349-2112
Practice Address - Fax:404-767-6533
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN066207367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000596296GMedicaid
GA000596296CMedicaid