Provider Demographics
NPI:1508301755
Name:MUNFORD, TONI (LPN)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:MUNFORD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 OCMULGEE ST E
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31001-4141
Mailing Address - Country:US
Mailing Address - Phone:478-217-1364
Mailing Address - Fax:
Practice Address - Street 1:126 OCMULGEE ST E
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31001-4141
Practice Address - Country:US
Practice Address - Phone:478-217-1364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA080632164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse