Individual
COURTNEY GIBBS STANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
325 MERCY ST, LAKE CITY, SC 29560-2331
(843) 374-6256
Mailing address
PO BOX 1479, LAKE CITY, SC 29560-1479
(843) 374-6256
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1297
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1297
STATE LICENSE #
SC
Enumeration date
06/09/2008
Last updated
06/09/2008
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