Healthcare Provider Details

I. General information

NPI: 1972663037
Provider Name (Legal Business Name): STANLEY ALLEN GILES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 E VANN RD
GREENEVILLE TN
37743-7202
US

IV. Provider business mailing address

PO BOX 37087
BALTIMORE MD
21297-3087
US

V. Phone/Fax

Practice location:
  • Phone: 423-278-1788
  • Fax: 423-278-1712
Mailing address:
  • Phone: 828-687-6282
  • Fax: 828-687-6285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12968
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: