Provider Demographics
NPI:1932202348
Name:FORD, GEORGE WILLIAM (DMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WILLIAM
Last Name:FORD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605A BEAVER RUIN ROAD
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3430
Mailing Address - Country:US
Mailing Address - Phone:770-381-0703
Mailing Address - Fax:770-381-6310
Practice Address - Street 1:605A BEAVER RUIN ROAD
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3430
Practice Address - Country:US
Practice Address - Phone:770-381-0703
Practice Address - Fax:770-381-6310
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist