Provider Demographics
NPI:1215099106
Name:WARD, CONNIE LOUISE
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:LOUISE
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10384 HIGHWAY 157
Mailing Address - Street 2:
Mailing Address - City:RISING FAWN
Mailing Address - State:GA
Mailing Address - Zip Code:30738-2219
Mailing Address - Country:US
Mailing Address - Phone:706-398-0573
Mailing Address - Fax:
Practice Address - Street 1:10384 HIGHWAY 157
Practice Address - Street 2:
Practice Address - City:RISING FAWN
Practice Address - State:GA
Practice Address - Zip Code:30738-2219
Practice Address - Country:US
Practice Address - Phone:706-398-0573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator