Individual
KELSEY CHASON STANFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11248 US HIGHWAY 341, FORT VALLEY, GA 31030-6626
(770) 547-3447
Mailing address
11248 US HIGHWAY 341, FORT VALLEY, GA 31030-6626
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
63902
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
GA
Other
Enumeration date
12/26/2018
Last updated
08/22/2022
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