Charles Tanner Stafford, MD
Individual provider Active NPI Gynecology Physician · Bainbridge, GA
NPI 1104074699 · NPPES record last updated Feb 21, 2013
Key facts
- NPI
- 1104074699
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gynecology Physician 207VG0400X
- License
- 017767 (GA)
- Practice address
- 119 N. Donalson St.
Suite B
Bainbridge, GA 39817 - Phone
- (229) 220-0780
- NPI assigned
- Sep 9, 2008
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 017767 | GA | MD | Gynecology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | 017767 | GA | Yes |
Addresses
Primary practice location
119 N. Donalson St.
Suite B
Bainbridge, GA 39817
Mailing address
119 N. Donalson St.
Suite B
Bainbridge, GA 39817
Phone (229) 220-0780
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All providers in Bainbridge, GA · Gynecology Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.