Healthcare Provider Details

I. General information

NPI: 1578182358
Provider Name (Legal Business Name): JEREMY DEANGELO STOCKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 MEDICAL PARK DR STE 1100
AUSTELL GA
30106-1110
US

IV. Provider business mailing address

301 GOVERNORS DR SE
HUNTSVILLE AL
35801
US

V. Phone/Fax

Practice location:
  • Phone: 770-874-0692
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number43087
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number109477
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: