MEDICARE: STACY HAMMOND STORY III M.D.

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
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	017559	GA
2	207L00000X	Anesthesiology Physician	017559	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	050045947	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043245939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY HAMMOND STORY III M.D.

Provider Business Mailing Address
First Line	:	2231 CUMMING RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30904-4335
Country	:	US
Telephone Number	:	706-829-3516
Fax Number	:	706-733-8044

Provider Business Practice Location Address
First Line	:	501 BLACKBURN DR
Second Line	:
City	:	MARTINEZ
State	:	GA
Zip	:	30907-8201
Country	:	US
Telephone Number	:	706-854-8340
Fax Number	:	706-854-8388

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	03/12/2020

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