Provider Demographics
NPI:1548313133
Name:MUSICK, STANLEY CARROLL (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:CARROLL
Last Name:MUSICK
Suffix:
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 1:147 MARQUIS DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1566
Mailing Address - Country:US
Mailing Address - Phone:601-668-6469
Mailing Address - Fax:
Practice Address - Street 1:147 MARQUIS DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1566
Practice Address - Country:US
Practice Address - Phone:601-668-6469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1879207L00000X, 207V00000X
TXG3630207L00000X
MS18415207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology