Provider Demographics
NPI:1093100513
Name:DAFFORN, ANDREW WARREN
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:WARREN
Last Name:DAFFORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 BOB JONES RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35769-6306
Mailing Address - Country:US
Mailing Address - Phone:256-244-4548
Mailing Address - Fax:
Practice Address - Street 1:1104 BOB JONES RD
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35769-6306
Practice Address - Country:US
Practice Address - Phone:256-244-4548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS10732390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program