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General NPI Number Information
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NPI Number | 1265267371
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Entity Type | Individual
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Provider Name | MICAH STUMAN
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Gender | Male
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Dates
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Enumeration Date | 09/06/2024
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 758 OLD NORCROSS RD STE 100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3386
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Country | US
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Telephone | 770-962-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 4025 MCGINNIS FERRY RD APT 510
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City | SUWANEE
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State | GA
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Zip | 30024-8323
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Country | US
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Telephone | 770-722-1813
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PT017369
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License Number State | GA
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