Basic Information
| Provider Information | |||||||||
| NPI: | 1831400449 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORD | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 326 ASBURY AVE | ||||||||
| Address2: | |||||||||
| City: | RIPLEY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380635577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312212200 | ||||||||
| FaxNumber: | 8653058894 | ||||||||
| Practice Location | |||||||||
| Address1: | 326 ASBURY AVE | ||||||||
| Address2: | |||||||||
| City: | RIPLEY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380635577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312212200 | ||||||||
| FaxNumber: | 8653058894 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2010 | ||||||||
| LastUpdateDate: | 08/29/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 49829 | TN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.