Provider Demographics
NPI:1861048662
Name:FLANDERS, STANLEY BERNARD SR
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:BERNARD
Last Name:FLANDERS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 ALAN LN
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-7118
Mailing Address - Country:US
Mailing Address - Phone:229-726-4954
Mailing Address - Fax:
Practice Address - Street 1:26 ALAN LN
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31793-7118
Practice Address - Country:US
Practice Address - Phone:229-726-4954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor