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General NPI Number Information
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NPI Number | 1548313133
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Entity Type | Individual
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Provider Name | STANLEY CARROLL MUSICK M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 02/22/2017
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Provider Practice Location Address
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Address Line | 147 MARQUIS DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1566
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Country | US
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Telephone | 601-668-6469
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Fax |
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Provider Business Mailing Address
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Address Line | 147 MARQUIS DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1566
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Country | US
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Telephone | 601-668-6469
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | E1879
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G3630
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 18415
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | E1879
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License Number State | AR
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