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NPI Code Detail

MEDICARE: TEGAN STUBER

MEDICARE: TEGAN STUBER
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
12471C3401XComputed Tomography Radiologic TechnologistGA

General Provider Information

NPI Number : 1164378071
Entity Type Code : Individual
Provider Name (Legal Business Name) : TEGAN STUBER
Provider Business Mailing Address
First Line : 111 LINDEN LN
Second Line :
City : LEXINGTON
State : NC
Zip : 27292-4864
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1263 COBB PKWY N
Second Line :
City : MARIETTA
State : GA
Zip : 30062-2421
Country : US
Telephone Number : 770-852-3400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2026
Last Update Date : 03/05/2026

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Directions to “ TEGAN STUBER ” Practice Location

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