Provider Demographics
NPI:1992825152
Name:STANLEY, CORY M (PA)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:M
Last Name:STANLEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8390
Mailing Address - Country:US
Mailing Address - Phone:828-275-1860
Mailing Address - Fax:
Practice Address - Street 1:3245 PEACHTREE PKWY # D188
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6054
Practice Address - Country:US
Practice Address - Phone:888-353-6843
Practice Address - Fax:912-303-7167
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01166363A00000X
GA005034363A00000X
FLPA9116822363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA01061992OtherAMERIGROUP
GA567447065FOtherMEDICAID ID FOR URGENTONE
SCGPA892OtherMEDICAID GROUP ID FOR URGENTONE
GAP00441750OtherRR MEDICARE ID FOR URGENTONE
SC0580PAOtherMEDICAID ID FOR URGENTONE
GA567447065BMedicaid
GA567447065Medicaid
GA567447065EOtherMEDICAID ID FOR URGENTONE
GA567447065CMedicaid
GA567447065AMedicaid
GA511I970040OtherMEDICARE ID FOR URGENTONE
SCGPA9002OtherMEDICAID GROUP ID FOR URGENTONE
GA567447065DMedicaid
SCGPA892OtherMEDICAID GROUP ID FOR URGENTONE
GA567447065AMedicaid
GA567447065Medicaid