Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 36377 | SC |
N | 207RC0000X | Internist - Cardiovascular Disease | 024969 | LA |
NPI | 1003000936 |
---|---|
Provider Name | Mark A Stellingworth |
First Address | Atlanta, GA 30374-3904 |
Second Address | Hartsville, SC 29550-4779 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2007 |
Last Update Date | 25/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
024969 | MEDICAL LICENSE (01) | LA |
363779 | (05) | SC |
TL36377 | MEDICAL LICENSE (01) | SC |