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NPI Code Detail

MEDICARE: RICHARD JOHN STAIE P.A.

MEDICARE: RICHARD JOHN STAIE P.A.
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
1363A00000XPhysician Assistant003918GA
2367H00000XAnesthesiologist Assistant003918GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659353357
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD JOHN STAIE P.A.
Provider Business Mailing Address
First Line : 610 ACADIA DR # 7131
Second Line :
City : ELLIJAY
State : GA
Zip : 30540-5986
Country : US
Telephone Number : 770-634-1287
Fax Number :
Provider Business Practice Location Address
First Line : 8954 HOSPITAL DR
Second Line :
City : DOUGLASVILLE
State : GA
Zip : 30134-2272
Country : US
Telephone Number : 770-920-6413
Fax Number : 678-838-2532
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2005
Last Update Date : 05/29/2013

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Directions to “ RICHARD JOHN STAIE P.A.” Practice Location

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