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NPI Code Detail

MEDICARE: MR. JOHN LEE STANTON JR. AGPCNP-BC, APRN

MEDICARE: MR. JOHN LEE STANTON JR. AGPCNP-BC, APRN
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
1163W00000XRegistered NurseRN272616GA
2363LA2200XAdult Health Nurse PractitionerRN272616GA
3363LG0600XGerontology Nurse PractitionerRN272616GA
4363LP2300XPrimary Care Nurse PractitionerRN272616GA

General Provider Information

NPI Number : 1851850788
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN LEE STANTON JR. AGPCNP-BC, APRN
Provider Business Mailing Address
First Line : 819 HIGHLAND GREEN WAY NE
Second Line :
City : ATLANTA
State : GA
Zip : 30306-5212
Country : US
Telephone Number : 678-522-3224
Fax Number :
Provider Business Practice Location Address
First Line : 3350 BRECKINRIDGE BLVD STE 200
Second Line :
City : DULUTH
State : GA
Zip : 30096-4959
Country : US
Telephone Number : 770-962-8396
Fax Number : 678-990-6429
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2019
Last Update Date : 03/19/2019

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