Healthcare Provider Details

I. General information

NPI: 1639622574
Provider Name (Legal Business Name): S. H. STORY, III, MD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BLACKBURN DR
MARTINEZ GA
30907-8201
US

IV. Provider business mailing address

PO BOX 3967
AUGUSTA GA
30914-3967
US

V. Phone/Fax

Practice location:
  • Phone: 706-854-8340
  • Fax: 706-854-8388
Mailing address:
  • Phone: 864-704-8829
  • Fax: 706-854-8388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number017559
License Number StateGA

VIII. Authorized Official

Name: DR. STACY H. STORY III
Title or Position: PHYSICIAN
Credential: MD
Phone: 706-829-3516