Provider Demographics
NPI:1417479411
Name:LIVING STONE HOUSE CALLS
Entity Type:Organization
Organization Name:LIVING STONE HOUSE CALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-401-6515
Mailing Address - Street 1:PO BOX 135
Mailing Address - Street 2:
Mailing Address - City:LAVONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30553-0135
Mailing Address - Country:US
Mailing Address - Phone:770-401-6515
Mailing Address - Fax:
Practice Address - Street 1:2275 GREESON RD NE
Practice Address - Street 2:
Practice Address - City:STATHAM
Practice Address - State:GA
Practice Address - Zip Code:30666-2111
Practice Address - Country:US
Practice Address - Phone:770-401-6516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service