MEDICARE: STAFFORD FAMILY CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1477121168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAFFORD FAMILY CARE

Provider Business Mailing Address
First Line	:	7317 CLINTON HWY STE 101
Second Line	:
City	:	POWELL
State	:	TN
Zip	:	37849-5209
Country	:	US
Telephone Number	:	865-340-6346
Fax Number	:	865-999-1353

Provider Business Practice Location Address
First Line	:	7317 CLINTON HWY STE 101
Second Line	:
City	:	POWELL
State	:	TN
Zip	:	37849-5209
Country	:	US
Telephone Number	:	865-340-6346
Fax Number	:	865-999-1353

Authorized Official
Title or Position	:	VP / OPERATIONS MANAGER
Name	:	GLEN STAFFORD
Credential	:
Telephone Number	:	802-922-0893

Provider Enumeration Date	:	06/17/2021
Last Update Date	:	03/10/2026

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Directions to “STAFFORD FAMILY CARE ” Practice Location

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