Provider Demographics
NPI:1265534069
Name:STANTON, NATHAN A (PA)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:A
Last Name:STANTON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N 20TH ST STE 19
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5456
Mailing Address - Country:US
Mailing Address - Phone:334-749-8146
Mailing Address - Fax:334-737-6432
Practice Address - Street 1:121 N 20TH ST STE 19
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5456
Practice Address - Country:US
Practice Address - Phone:334-749-8146
Practice Address - Fax:334-737-6432
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA442363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-02245OtherBCBS PMD
AL009941187Medicaid
AL051556771Medicaid
AL051556771Medicaid
ALQ53053Medicare UPIN