| Doctor Name: | CHARLES TANNER STAFFORD |
| NPI Number: | 1104074699 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 017767 |
| Business Practice Address: | 119 N. Donalson St. Suite B Bainbridge, GA - 39817 |
| Business Phone Number: | 2292200780 |
| Business Fax Number: | |
| Mailing Address: | 119 N. Donalson St., Suite B BAINBRIDGE |
| State: | GA |
| Postal Code: | 39817 |
| Phone Number: | 2292200780 |
| Fax Number: | |
| NPI Enumeration Date: | 09/09/2008 |
| NPI Last Update Date: | 02/21/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207VG0400X |
| License Number: | 017767 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | Gynecology |
| Taxonomy Definition: | |