Provider Demographics
NPI:1023024924
Name:CHILDERS, STANLEY FLOYD (DMD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:FLOYD
Last Name:CHILDERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LAKE HERON CT W
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4041
Mailing Address - Country:US
Mailing Address - Phone:912-450-1680
Mailing Address - Fax:
Practice Address - Street 1:109 OGLESBY AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:GA
Practice Address - Zip Code:31408-1611
Practice Address - Country:US
Practice Address - Phone:912-966-2102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA96251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00249906AMedicaid