Healthcare Provider Details

I. General information

NPI: 1316047400
Provider Name (Legal Business Name): STANLEY WAYNE HIMES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 PEACHTREE ST NE
ATLANTA GA
30309-2433
US

IV. Provider business mailing address

1605 PEACHTREE ST NE
ATLANTA GA
30309-2433
US

V. Phone/Fax

Practice location:
  • Phone: 706-580-4059
  • Fax:
Mailing address:
  • Phone: 706-580-4059
  • Fax: 706-544-1543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number033839
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number33839
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number33839
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: