Provider Demographics
NPI:1851850788
Name:STANTON, JOHN LEE JR (AGPCNP-BC, APRN)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LEE
Last Name:STANTON
Suffix:JR
Gender:M
Credentials:AGPCNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 HIGHLAND GREEN WAY NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-5212
Mailing Address - Country:US
Mailing Address - Phone:678-522-3224
Mailing Address - Fax:
Practice Address - Street 1:3350 BRECKINRIDGE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4959
Practice Address - Country:US
Practice Address - Phone:770-962-8396
Practice Address - Fax:678-990-6429
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN272616163W00000X, 363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology