Provider Demographics
NPI:1518010537
Name:STANFORD, TODD E (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:E
Last Name:STANFORD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 N. LYERLY ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404
Mailing Address - Country:US
Mailing Address - Phone:423-698-0850
Mailing Address - Fax:423-698-0511
Practice Address - Street 1:281 N. LYERLY ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-698-0850
Practice Address - Fax:423-698-0511
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4958363A00000X
TN1448363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4223195OtherBCBS OF TN
TN36699031Medicare PIN
P27884Medicare UPIN