Provider Demographics
NPI:1023095536
Name:IRELAND, STANLEY M (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:M
Last Name:IRELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:800-480-5243
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:3257 CHATTANOOGA VALLEY RD STE 200
Practice Address - Street 2:
Practice Address - City:FLINTSTONE
Practice Address - State:GA
Practice Address - Zip Code:30725-2387
Practice Address - Country:US
Practice Address - Phone:706-841-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA29682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3028505Medicare ID - Type Unspecified
GA08BBWXMMedicare ID - Type Unspecified