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General NPI Number Information
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NPI Number | 1679890594
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Entity Type | Individual
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Provider Name | JONATHAN DANIEL STEGALL M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2010
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 3333 OLD MILTON PKWY STE 560
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City | ALPHARETTA
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State | GA
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Zip | 30005-4437
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Country | US
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Telephone | 770-551-2730
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Fax | 770-551-2731
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Provider Business Mailing Address
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Address Line | 3333 OLD MILTON PKWY STE 560
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City | ALPHARETTA
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State | GA
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Zip | 30005-4437
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Country | US
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Telephone | 770-551-2730
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Fax | 770-551-2731
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 069967
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 69967
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License Number State | GA
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