Stallworth Afc #1 Corporation

Primary specialty

ContractorTaxonomy code 171W00000X

Legal business name

STALLWORTH AFC #1 CORPORATION

Practice address

645 E Grand Blvd
Detroit, MI 48207-3512

Phone

(313) 319-5526

Fax

(313) 823-8284

NPI assigned

Oct 26, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Gail Stallworth

Title

Administrator

Phone

(313) 319-5526

Specialties & licenses 1

Addresses

Other names 1

• stallworth afc Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609951599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 07250",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48207",
            "telephone_number": "313-319-5526",
            "fax_number": "313-823-8284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 E GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482073512",
            "telephone_number": "313-319-5526",
            "fax_number": "313-823-8284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STALLWORTH AFC #1 CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STALLWORTH",
        "authorized_official_first_name": "GAIL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "313-319-5526",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Contractor",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "stallworth afc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kimberly J Stafford, LPC
• Serah Stafford
• Lisa D. Stagner, D.O.
• Alexandra D Staley, MA, TLLP
• Jeffery Harrison Stallings, L.L.P.
• Perris J Stallworth
• Jessica Lynn Stamatis, PAC
• Michael John Stamey, DPM
• Brandi Stancu
• Standard Care, Inc.

• Contractor in Detroit, MI
• Providers in Detroit, MI by specialty
• Contractor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.