MEDICARE: S. H. STORY, III, MD, P.C.

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	207L00000X	Anesthesiology Physician	017559	GA

General Provider Information

NPI Number	:	1639622574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S. H. STORY, III, MD, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 3967
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30914-3967
Country	:	US
Telephone Number	:	864-704-8829
Fax Number	:	706-854-8388

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	:	PHYSICIAN
Name	:	DR. STACY H. STORY III
Credential	:	MD
Telephone Number	:	706-829-3516

Provider Enumeration Date	:	07/27/2016
Last Update Date	:	09/19/2023

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