Healthcare Provider Details

I. General information

NPI: 1104100916
Provider Name (Legal Business Name): FABIAN A STONE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PERIMETER PARK DR SUITE 201
ATLANTA GA
30341-1334
US

IV. Provider business mailing address

30 PERIMETER PARK DR SUITE 201
ATLANTA GA
30341-1334
US

V. Phone/Fax

Practice location:
  • Phone: 479-201-8212
  • Fax: 866-828-7724
Mailing address:
  • Phone: 479-201-8212
  • Fax: 866-828-7724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: