Healthcare Provider Details

I. General information

NPI: 1093986192
Provider Name (Legal Business Name): STEPHEN G. PAPPAS, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 PARKWOOD DR
BRUNSWICK GA
31520-4725
US

IV. Provider business mailing address

2600 PARKWOOD DR
BRUNSWICK GA
31520-4725
US

V. Phone/Fax

Practice location:
  • Phone: 912-264-9999
  • Fax: 912-264-8099
Mailing address:
  • Phone: 912-264-9999
  • Fax: 912-264-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number029509
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number029509
License Number StateGA

VIII. Authorized Official

Name: STEPHEN G PAPPAS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 912-264-9999