Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 022652 | GA |
NPI | 1073500898 |
---|---|
Provider Name | Michael Barry Stubbs |
First Address | Decatur, GA 30033-6131 |
Second Address | Decatur, GA 30033-6131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 17/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000222252A | (05) | GA |
D41190 | (02) | GA |