Provider Demographics
NPI:1679654693
Name:FORDHAM, DEBORAH WARE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:WARE
Last Name:FORDHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 60-1
Mailing Address - Street 2:1127 REBIE ROAD
Mailing Address - City:CHESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31012-9538
Mailing Address - Country:US
Mailing Address - Phone:478-358-4370
Mailing Address - Fax:
Practice Address - Street 1:1826 VETERANS BOULEVARD
Practice Address - Street 2:CARL VINSON VA MEDICAL CENTER
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021
Practice Address - Country:US
Practice Address - Phone:478-272-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002877363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1032004OtherNATIONAL NCCPA NUMBER
GA002877OtherPA-C NUMBER
GAS51138Medicare ID - Type Unspecified