Provider Demographics
NPI:1902895824
Name:CHITTY, STEPHEN A IV (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:CHITTY
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 STARLING ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4265
Mailing Address - Country:US
Mailing Address - Phone:912-466-5504
Mailing Address - Fax:912-466-5593
Practice Address - Street 1:2500 STARLING ST
Practice Address - Street 2:SUITE 504
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4265
Practice Address - Country:US
Practice Address - Phone:912-466-5504
Practice Address - Fax:912-466-5593
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA056030207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA190251658BMedicaid
GAP00345732OtherRAILROAD MEDICARE
GA190251658CMedicaid
GAP00345732OtherRAILROAD MEDICARE
GAI27398Medicare UPIN