MEDICARE: DR. STUART J PANCER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	040187	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124014022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART J PANCER MD

Provider Business Mailing Address
First Line	:	2199 COLLEGE AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30317-1334
Country	:	US
Telephone Number	:	770-396-2496
Fax Number	:	770-493-6189

Provider Business Practice Location Address
First Line	:	2199 COLLEGE AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30317-1334
Country	:	US
Telephone Number	:	770-396-2496
Fax Number	:	770-493-6189

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	11/16/2016

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