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General NPI Number Information
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NPI Number | 1518334200
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Entity Type | Organization
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Legal Business Name | MIGUEL E STUBBS M D P C
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 08/28/2015
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Provider Practice Location Address
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Address Line | 230 BEAVER FALLS PL SW
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City | ATLANTA
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State | GA
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Zip | 30331-8326
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Country | US
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Telephone | 404-803-5246
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Fax | 770-991-5012
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Provider Business Mailing Address
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Address Line | 230 BEAVER FALLS PL SW
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City | ATLANTA
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State | GA
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Zip | 30331-8326
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Country | US
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Telephone | 404-803-5246
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Fax | 770-991-5012
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Authorized Official
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Title or Position | CEO
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Name | DR. MIGUEL E STUBBS
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Credential | MD
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Telephone | 404-803-5246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 037708
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License Number State | GA
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