Provider Demographics
NPI:1770768541
Name:STEBBINS, STANTON A (MD)
Entity type:Individual
Prefix:DR
First Name:STANTON
Middle Name:A
Last Name:STEBBINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11050 CRABAPPLE ROAD
Mailing Address - Street 2:STE. 120
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075
Mailing Address - Country:US
Mailing Address - Phone:770-518-9277
Mailing Address - Fax:770-518-8718
Practice Address - Street 1:11050 CRABAPPLE ROAD
Practice Address - Street 2:STE. 120
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075
Practice Address - Country:US
Practice Address - Phone:770-518-9277
Practice Address - Fax:770-518-8718
Is Sole Proprietor?:No
Enumeration Date:2007-12-29
Last Update Date:2018-06-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA002116208000000X
GA062439208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA498346592BMedicaid
GA498346592AMedicaid