Individual
JILL STANTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20 POINTE NORTH DR STE 109, CARTERSVILLE, GA 30120-7955
(678) 524-1262
(470) 588-8934
Mailing address
1905 COUNTRYSIDE PL SE, SMYRNA, GA 30080-8251
(678) 524-1262
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT006415
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003178127B
—
GA
Enumeration date
03/30/2016
Last updated
07/30/2020
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