Healthcare Provider Details

I. General information

NPI: 1558368415
Provider Name (Legal Business Name): JOSE PABLO STOLOVITZKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5673 PEACHTREE DUNWOODY RD STE 150
ATLANTA GA
30342-1731
US

IV. Provider business mailing address

5673 PEACHTREE DUNWOODY RD STE 150
ATLANTA GA
30342-1731
US

V. Phone/Fax

Practice location:
  • Phone: 404-297-1780
  • Fax: 404-252-7255
Mailing address:
  • Phone: 404-297-1780
  • Fax: 404-252-7255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number029536
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number029536
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: