Provider Demographics
NPI:1699703041
Name:WARD, ERIC M (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
Last Name:WARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 CONNELL RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1407
Mailing Address - Country:US
Mailing Address - Phone:229-244-1570
Mailing Address - Fax:229-247-1084
Practice Address - Street 1:410 CONNELL RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1407
Practice Address - Country:US
Practice Address - Phone:229-244-1570
Practice Address - Fax:229-247-1084
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053201207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA830132617AMedicaid
GA10BDHGFMedicare ID - Type Unspecified
GA830132617AMedicaid