Provider Demographics
NPI:1730395039
Name:STEPHEN NEIL MEYERS MD PC
Entity type:Organization
Organization Name:STEPHEN NEIL MEYERS MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-333-0504
Mailing Address - Street 1:PO BOX 3131
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31604-3131
Mailing Address - Country:US
Mailing Address - Phone:229-333-0504
Mailing Address - Fax:229-333-0150
Practice Address - Street 1:2704 NORTH OAK STREET
Practice Address - Street 2:BUILDING M
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1791
Practice Address - Country:US
Practice Address - Phone:229-333-0504
Practice Address - Fax:229-333-0150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0228412083X0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAA002OtherTRICARE
GA00253096HMedicaid
GA202G086627OtherMEDICARE PTAN
GA202G086627OtherMEDICARE PTAN
GA00253096HMedicaid