# STANFORD MEDICAL GROUP, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457521940
- **Authorized official:** JEANETTE JUNCO PATINO (OWNER)
- **Authorized official phone:** (786) 837-1175

## Contact information

- **Practice address:** 142 MITCHELL ST SW, SUITE 200, ATLANTA, GA 30303-3439
- **Practice address phone:** (404) 584-2105
- **Practice address fax:** (404) 584-2106
- **Mailing address:** 142 MITCHELL ST SW, SUITE 200, ATLANTA, GA 30303-3439
- **Mailing address phone:** (404) 584-2105
- **Mailing address fax:** (404) 584-2106

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |
| 225100000X | Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 03/11/2008
- **Last updated:** 06/05/2008