MEDICARE: DR. MARK ANTHONY STILLMAN PH.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	103TC0700X	Clinical Psychologist	PSY003631	GA

General Provider Information

NPI Number	:	1982948154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ANTHONY STILLMAN PH.D.

Provider Business Mailing Address
First Line	:	4274 PEACHTREE RD NE
Second Line	:	SUITE 203
City	:	ATLANTA
State	:	GA
Zip	:	30319-3015
Country	:	US
Telephone Number	:	678-805-7238
Fax Number	:

Provider Business Practice Location Address
First Line	:	4274 PEACHTREE RD NE
Second Line	:	SUITE 203
City	:	ATLANTA
State	:	GA
Zip	:	30319-3015
Country	:	US
Telephone Number	:	678-805-7238
Fax Number	:

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

Provider Enumeration Date	:	11/12/2012
Last Update Date	:	07/18/2013

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