Provider Demographics
NPI:1245416585
Name:SANFORD, RYAN EDWARD
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:EDWARD
Last Name:SANFORD
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 1:814 RADFORD BLVD
Mailing Address - Street 2:20328
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31704-1130
Mailing Address - Country:US
Mailing Address - Phone:229-639-5540
Mailing Address - Fax:
Practice Address - Street 1:814 RADFORD BLVD
Practice Address - Street 2:20328
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31704-1130
Practice Address - Country:US
Practice Address - Phone:229-639-5540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman