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General NPI Number Information
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NPI Number | 1003826041
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Entity Type | Organization
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Legal Business Name | RAYMOND L. STOVALL, M.D., P.C.
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 600 PROFESSIONAL DR SUITE 150
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-7651
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Country | US
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Telephone | 678-376-1800
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Fax | 678-376-5500
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Provider Business Mailing Address
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Address Line | 600 PROFESSIONAL DR SUITE 150
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-7651
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Country | US
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Telephone | 678-376-1800
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Fax | 678-376-5500
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAYMOND L STOVALL
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Credential | M.D.
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Telephone | 678-376-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 025291
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License Number State | GA
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