Provider Demographics
NPI:1063587533
Name:WARD, RALPH O JR (LMSW)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:O
Last Name:WARD
Suffix:JR
Gender:M
Credentials:LMSW
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Mailing Address - Street 1:300 E HOSPITAL RD
Mailing Address - Street 2:ROOM 13A-10
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5650
Mailing Address - Country:US
Mailing Address - Phone:706-787-3656
Mailing Address - Fax:706-787-8081
Practice Address - Street 1:300 E HOSPITAL RD.
Practice Address - Street 2:DWIGHT D EISENHOWER ARMY MEDICAL CENTER
Practice Address - City:FT. GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905
Practice Address - Country:US
Practice Address - Phone:706-787-3656
Practice Address - Fax:706-787-8081
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6801061240104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN