Provider Demographics
NPI:1063866705
Name:STANFORD, JAMES KEITH II (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KEITH
Last Name:STANFORD
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:615-465-7361
Mailing Address - Fax:615-628-6877
Practice Address - Street 1:2200 HIGHWAY 61 N STE 2300
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-8246
Practice Address - Country:US
Practice Address - Phone:601-883-3320
Practice Address - Fax:601-883-3326
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MST-3219207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01882015Medicaid