Healthcare Provider Details

I. General information

NPI: 1225087745
Provider Name (Legal Business Name): INFECTIOUS DISEASE CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 11/15/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 LAUREL SPRINGS PKWY STE 1404
SUWANEE GA
30024-6098
US

IV. Provider business mailing address

5400 LAUREL SPRINGS PKWY STE 1404
SUWANEE GA
30024-6098
US

V. Phone/Fax

Practice location:
  • Phone: 678-347-2153
  • Fax:
Mailing address:
  • Phone: 678-347-2153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN KYLE STELLBAUER
Title or Position: COO
Credential:
Phone: 678-347-2153