Individual
JON L STANFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
119 AMBULANCE DR # DT, SUITE 202, CARROLLTON, GA 30117-3857
(770) 834-3336
(770) 832-2331
Mailing address
157 CLINIC AVE, SUITE 302, CARROLLTON, GA 30117-4454
(770) 834-3336
(770) 832-2331
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
24016
SC
208600000X
Surgery Physician
Primary
065186
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
T81177
—
SC
Enumeration date
05/22/2006
Last updated
08/08/2013
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