Provider Demographics
NPI:1902412208
Name:STANFORD, TONI BRENNETTE
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:BRENNETTE
Last Name:STANFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MOUNTAINVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-7191
Mailing Address - Country:US
Mailing Address - Phone:404-688-6731
Mailing Address - Fax:
Practice Address - Street 1:600 MOUNTAINVIEW DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-7191
Practice Address - Country:US
Practice Address - Phone:404-287-8428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN000006542376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide