Healthcare Provider Details

I. General information

NPI: 1013062108
Provider Name (Legal Business Name): JOHN L STANTON MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 E MAIN STREET SUITE A
ERIN TN
37061
US

IV. Provider business mailing address

331 LANDRUM PL
CLARKSVILLE TN
37043-6319
US

V. Phone/Fax

Practice location:
  • Phone: 931-905-1001
  • Fax: 931-905-0410
Mailing address:
  • Phone: 931-905-1001
  • Fax: 931-905-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD28572
License Number StateTN

VIII. Authorized Official

Name: MISS TAMIKKA R SCHMIDT
Title or Position: OFFICE MANAGER
Credential:
Phone: 931-905-1001