Healthcare Provider Details

I. General information

NPI: 1548579923
Provider Name (Legal Business Name): STEPHEN F PINKERTON, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 ROCK QUARRY RD
TOCCOA GA
30577-8721
US

IV. Provider business mailing address

PO BOX 609
TOCCOA GA
30577-1410
US

V. Phone/Fax

Practice location:
  • Phone: 706-886-7408
  • Fax: 706-886-6042
Mailing address:
  • Phone: 706-886-7408
  • Fax: 706-886-6042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number033877
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier52049095
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerBCBS GA
# 2
Identifier000471292A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 3
Identifier020015123
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerMEDICARE RAILROAD

VIII. Authorized Official

Name: STEPHEN FRANK PINKERTON
Title or Position: CEO
Credential: M.D.
Phone: 706-886-7408