| Stanford Medical Group, Inc | |
|
142 Mitchell St Sw Suite 200 Atlanta GA 30303-3439 | |
| (404) 584-2105 | |
| (404) 584-2106 |
| Full Name | Stanford Medical Group, Inc |
|---|---|
| Speciality | General Practice |
| Location | 142 Mitchell St Sw, Atlanta, Georgia |
| Authorized Official Name and Position | Jeanette Junco Patino (OWNER) |
| Authorized Official Contact | 7868371175 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stanford Medical Group, Inc 142 Mitchell St Sw Suite 200 Atlanta GA 30303-3439 Ph: (404) 584-2105 | Stanford Medical Group, Inc 142 Mitchell St Sw Suite 200 Atlanta GA 30303-3439 Ph: (404) 584-2105 |
| NPI Number | 1457521940 |
|---|---|
| Provider Enumeration Date | 03/11/2008 |
| Last Update Date | 06/05/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457521940 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 225100000X | Physical Therapist | (* (Not Available)) | Secondary |
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