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General NPI Number Information
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NPI Number | 1972827400
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Entity Type | Individual
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Provider Name | STACY KRUETH M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/26/2010
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 5671 PEACHTREE DUNWOODY RD STE 530
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City | ATLANTA
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State | GA
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Zip | 30342-5005
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Country | US
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Telephone | 404-257-1415
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Fax |
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Provider Business Mailing Address
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Address Line | 5671 PEACHTREE DUNWOODY RD STE 610
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City | ATLANTA
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State | GA
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Zip | 30342-5013
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Country | US
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Telephone | 404-257-1415
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Fax | 404-851-1649
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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 | A118109
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License Number State | CA
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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 | 79648
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License Number State | GA
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