Provider Demographics
NPI:1740777143
Name:TRAYLOR, STANLEY EUGENE III
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:EUGENE
Last Name:TRAYLOR
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GENE
Other - Middle Name:
Other - Last Name:TRAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 748519
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8519
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:
Practice Address - Street 1:820 PRUDENTIAL DR STE 510
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8207
Practice Address - Country:US
Practice Address - Phone:904-376-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS191092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry