Provider Demographics
NPI:1679547509
Name:SHUFORD, ALFRED BERNARD (MED,LAT,ATC)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:BERNARD
Last Name:SHUFORD
Suffix:
Gender:M
Credentials:MED,LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 MINTRIDGE RD
Mailing Address - Street 2:AIOSM
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-9242
Mailing Address - Country:US
Mailing Address - Phone:704-573-1940
Mailing Address - Fax:704-573-1940
Practice Address - Street 1:5201 MINTRIDGE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-9242
Practice Address - Country:US
Practice Address - Phone:704-573-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer