Basic Information
| Provider Information | |||||||||
| NPI: | 1649203357 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEDFORD | ||||||||
| FirstName: | LADONNA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9247 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319089247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063227884 | ||||||||
| FaxNumber: | 7062434354 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 19TH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319011528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063227884 | ||||||||
| FaxNumber: | 7062434354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 05/06/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN131920 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 000963509E | 05 | GA | MEDICAID | 20250I6945 | 01 | GA | MEDICARE PTAN | OTHER | 202I501203 | 01 | GA | MEDICARE PTAN | OTHER |