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General NPI Number Information
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NPI Number | 1477073989
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Entity Type | Individual
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Provider Name | JUSTIN STUBBS
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Gender | Male
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Dates
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Enumeration Date | 06/26/2017
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Last Update Date | 07/03/2017
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Provider Practice Location Address
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Address Line | 132 US HIGHWAY 280 W
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City | AMERICUS
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State | GA
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Zip | 31719-8645
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Country | US
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Telephone | 229-931-6830
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Fax | 229-931-7134
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Provider Business Mailing Address
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Address Line | 500 W 3RD AVE STE 101
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City | ALBANY
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State | GA
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Zip | 31701-1900
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Country | US
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Telephone | 229-312-5800
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Fax | 229-312-5853
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN203546
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License Number State | GA
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