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General NPI Number Information
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NPI Number | 1174078752
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Entity Type | Organization
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Legal Business Name | STECHISON NEUROSURGERY ATLANTA, LLC
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 08/24/2016
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Provider Practice Location Address
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Address Line | 743 OLD NORCROSS RD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4317
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Country | US
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Telephone | 404-683-5240
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Fax |
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Provider Business Mailing Address
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Address Line | 819 GLENDALE TER NE
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City | ATLANTA
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State | GA
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Zip | 30308-1652
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Country | US
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Telephone | 404-683-5240
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL THOMAS STECHISON
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Credential | M.D. PH.D.
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Telephone | 404-683-0240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 040561
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License Number State | GA
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