MEDICARE: STONEBRAKER'S INC.

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	MHL-060-1253	NC

General Provider Information

NPI Number	:	1811433386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STONEBRAKER'S INC.

Provider Business Mailing Address
First Line	:	5110 OLD ELLIS POINT
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076
Country	:	US
Telephone Number	:	770-751-8383
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 BLAIRHILL RD
Second Line	:	STE B-103
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-1565
Country	:	US
Telephone Number	:	704-679-9600
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	JENNY GUEST
Credential	:
Telephone Number	:	303-889-9504

Provider Enumeration Date	:	01/09/2017
Last Update Date	:	01/20/2026

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Directions to “STONEBRAKER'S INC. ” Practice Location

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