Individual
ERICK STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
30 SANDSTONE CIR, JACKSON, TN 38305-2073
(731) 240-1695
(731) 240-1694
Mailing address
9036 WEEPING CHERRY LN, CORDOVA, TN 38016-5373
(813) 796-2200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1191813
TN
363AM0700X
Medical Physician Assistant
1191813
TN
Other
Enumeration date
02/24/2022
Last updated
03/03/2022
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