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General NPI Number Information
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NPI Number | 1760710180
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Entity Type | Individual
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Provider Name | MICHAEL STONEBRAKER CSAC, CCS
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Gender | Male
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Dates
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Enumeration Date | 11/23/2009
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 5110 OLD ELLIS PT
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City | ROSWELL
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State | GA
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Zip | 30076-3863
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Country | US
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Telephone | 770-751-8383
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Fax | 770-751-7282
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Provider Business Mailing Address
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Address Line | 5110 OLD ELLIS PT
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City | ROSWELL
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State | GA
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Zip | 30076-3863
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Country | US
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Telephone | 770-751-8383
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Fax | 770-751-7282
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | MHL-041-742
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License Number State | NC
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