Provider Demographics
NPI:1427261304
Name:ALFORD, NICHOLAS (SST III)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:ALFORD
Suffix:
Gender:M
Credentials:SST III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 WATKINS LAKE WAY
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:GA
Mailing Address - Zip Code:31803-4251
Mailing Address - Country:US
Mailing Address - Phone:706-587-9985
Mailing Address - Fax:
Practice Address - Street 1:2100 COMER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8725
Practice Address - Country:US
Practice Address - Phone:706-596-5576
Practice Address - Fax:706-596-5747
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker