Active NPI
Garrad Stanfield
- Preferred Provider Organization
- Wake Forest, NC
National Provider Identifier
1710735964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Preferred Provider Organization
- License
- 20889954
- Practice address
- 2040 Rainy Lake St
Wake Forest, NC 27587-3419 - Phone
- (984) 297-4167
- NPI assigned
- May 10, 2024
- 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 |
|---|---|---|---|---|
| Preferred Provider Organization | 305R00000X | 20889954 | NC | Primary |
Addresses
Primary practice location
2040 Rainy Lake St
Wake Forest, NC 27587-3419
Mailing address
2040 Rainy Lake St
Wake Forest, NC 27587-3419
Phone (984) 297-4167
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20889954 | NC | MD | Preferred Provider Organization |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715299200000",
"number": "1710735964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2040 RAINY LAKE ST",
"city": "WAKE FOREST",
"state": "NC",
"postal_code": "275873419",
"telephone_number": "984-297-4167"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2040 RAINY LAKE ST",
"city": "WAKE FOREST",
"state": "NC",
"postal_code": "275873419",
"telephone_number": "984-297-4167"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STANFIELD",
"first_name": "GARRAD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-05-10",
"last_updated": "2024-05-10",
"certification_date": "2024-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "305R00000X",
"taxonomy_group": "",
"desc": "Preferred Provider Organization",
"state": "NC",
"license": "20889954",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wake Forest, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.