Healthcare Provider Details

I. General information

NPI: 1366463689
Provider Name (Legal Business Name): STUART ALVA BABCOCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 11/17/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 ABBINGTON WAY
CLARKESVILLE GA
30523-5248
US

IV. Provider business mailing address

153 ABBINGTON WAY
CLARKESVILLE GA
30523-5248
US

V. Phone/Fax

Practice location:
  • Phone: 706-599-6354
  • Fax:
Mailing address:
  • Phone: 706-599-6354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number035810
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: