Healthcare Provider Details

I. General information

NPI: 1134471071
Provider Name (Legal Business Name): STONE MOUNTAIN MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3608 NAPA CT
OCEANSIDE CA
92056-5461
US

IV. Provider business mailing address

3608 NAPA CT
OCEANSIDE CA
92056-5461
US

V. Phone/Fax

Practice location:
  • Phone: 760-473-8253
  • Fax:
Mailing address:
  • Phone: 760-473-8253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code209800000X
TaxonomyLegal Medicine (M.D./D.O.) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KARL E. STEINBERG
Title or Position: CEO
Credential: MD
Phone: 760-473-8253