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General NPI Number Information
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NPI Number | 1053874289
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Entity Type | Individual
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Provider Name | BRIANNA STADSVOLD MD
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Gender | Female
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Dates
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Enumeration Date | 04/14/2019
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Last Update Date | 04/14/2019
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Provider Practice Location Address
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Address Line | 1120 15TH ST
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City | AUGUSTA
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State | GA
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Zip | 30912-0004
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Country | US
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Telephone | 706-721-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 1814 VERDERY ST
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City | AUGUSTA
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State | GA
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Zip | 30904-5716
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Country | US
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Telephone | 229-251-3814
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 10776
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License Number State | GA
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