Organization
STANFORD MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANETTE JUNCO PATINO (OWNER)
(786) 837-1175
Entity
Organization
Contact information
Practice address
142 MITCHELL ST SW, SUITE 200, ATLANTA, GA 30303-3439
(404) 584-2105
(404) 584-2106
Mailing address
142 MITCHELL ST SW, SUITE 200, ATLANTA, GA 30303-3439
(404) 584-2105
(404) 584-2106
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
225100000X
Physical Therapist
—
—
Other
Enumeration date
03/11/2008
Last updated
06/05/2008
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