Stanford, Jon L
Stanford, Jon L is an individual health care provider with primary practice located at 119 Ambulance Dr # Dt Suite 202, Carrollton GA 30117-3857. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Stanford, Jon L can be contacted via phone (770) 834-3336.Contact Information
Primary practice address
119 Ambulance Dr # Dt Suite 202
Carrollton GA 30117-3857
Phone: (770) 834-3336
Fax: (770) 832-2331
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 24016 | South Carolina |
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 065186 | Georgia |
Profile Details
| NPI number | 1336193200 |
|---|---|
| LBN Legal business name | Stanford, Jon L |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 22nd, 2006 |
| Last updated | Aug 8th, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336193200 | NPPES |
| South Carolina | MEDICAID | T81177 |
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