Active NPI
Charles Tanner Stafford, MD
- Gynecology Physician
- Bainbridge, GA
National Provider Identifier
1104074699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- 017767
- Practice address
- 119 N. Donalson St.
Suite B
Bainbridge, GA 39817 - Phone
- (229) 220-0780
- NPI assigned
- Sep 9, 2008
- Last updated
- Feb 21, 2013
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | 017767 | GA | Primary |
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
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 017767 | GA | MD | Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1361404800000",
"number": "1104074699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "119 N. DONALSON ST.",
"address_2": "SUITE B",
"city": "BAINBRIDGE",
"state": "GA",
"postal_code": "39817",
"telephone_number": "229-220-0780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "119 N. DONALSON ST.",
"address_2": "SUITE B",
"city": "BAINBRIDGE",
"state": "GA",
"postal_code": "39817",
"telephone_number": "229-220-0780"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAFFORD",
"first_name": "CHARLES",
"middle_name": "TANNER",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-09-09",
"last_updated": "2013-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "GA",
"license": "017767",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bainbridge, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.