Active NPI
Michael Clayton Stafford, RD, LD
- Registered Dietitian
- Charleston, SC
National Provider Identifier
1073810214
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 570
- Practice address
- 86 Jonathan Lucas St
Charleston, SC 29425-8900 - Phone
- (843) 792-3101
- Fax
- (843) 792-4080
- NPI assigned
- Feb 24, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 570 | SC | Primary |
Addresses
Primary practice location
86 Jonathan Lucas St
Charleston, SC 29425-8900
Mailing address
86 Jonathan Lucas St
Charleston, SC 29425-8900
Phone (843) 792-3101
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 570 | SC | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1298505600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298505600000",
"number": "1073810214",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "86 JONATHAN LUCAS ST",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294258900",
"telephone_number": "843-792-3101",
"fax_number": "843-792-4080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "86 JONATHAN LUCAS ST",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294258900",
"telephone_number": "843-792-3101",
"fax_number": "843-792-4080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAFFORD",
"first_name": "MICHAEL",
"middle_name": "CLAYTON",
"name_prefix": "Mr.",
"credential": "RD, LD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-02-24",
"last_updated": "2011-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "SC",
"license": "570",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charleston, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.