Doctor Name: | JON L STANFORD |
NPI Number: | 1336193200 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 24016 |
Business Practice Address: | 119 Ambulance Dr # Dt Suite 202 Carrollton, GA - 301173857 |
Business Phone Number: | 7708343336 |
Business Fax Number: | 7708322331 |
Mailing Address: | 157 Clinic Ave, Suite 302 CARROLLTON |
State: | GA |
Postal Code: | 301174454 |
Phone Number: | 7708343336 |
Fax Number: | 7708322331 |
NPI Enumeration Date: | 05/22/2006 |
NPI Last Update Date: | 08/08/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 24016 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | SC |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |