MEDICARE: G. CLARK STULL, DC PC

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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1811516891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G. CLARK STULL, DC PC

Provider Business Mailing Address
First Line	:	2169 INGLESIDE AVE
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31204-2029
Country	:	US
Telephone Number	:	478-474-2344
Fax Number	:	478-746-0262

Provider Business Practice Location Address
First Line	:	2169 INGLESIDE AVE
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31204-2029
Country	:	US
Telephone Number	:	478-474-2344
Fax Number	:	478-746-0262

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	HANNAH KIMBELL
Credential	:
Telephone Number	:	478-474-2344

Provider Enumeration Date	:	04/10/2020
Last Update Date	:	04/10/2020

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