Basic Information
| Provider Information | |||||||||
| NPI: | 1700844321 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAFOR | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | N. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 PRESTON CT | ||||||||
| Address2: | STE 103 | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312105772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787452385 | ||||||||
| FaxNumber: | 4787451225 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 PRESTON CT | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312105772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787452385 | ||||||||
| FaxNumber: | 4787451225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 12/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | 57329 | GA | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 208VP0000X | 57329 | GA | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 207L00000X | 57329 | GA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 57329 | GA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 781749283E | 05 | GA | MEDICAID | 57329 | 01 | GA | GA MEDICAL LICENSE | OTHER | 781749283D | 05 | GA | MEDICAID |