Provider Demographics
NPI:1861402695
Name:STOVALL, RAYMOND L (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:L
Last Name:STOVALL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:600 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8717
Mailing Address - Country:US
Mailing Address - Phone:678-376-1800
Mailing Address - Fax:678-376-5500
Practice Address - Street 1:600 PROFESSIONAL DR
Practice Address - Street 2:SUITE 150
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8717
Practice Address - Country:US
Practice Address - Phone:678-376-1800
Practice Address - Fax:678-376-5500
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2009-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA025291207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4031478OtherAETNA
GA743055533OtherUNITED HEATLHCARE
GA743055533OtherBEECHSTREET
GA00282675BMedicaid
GA743055533OtherCAPP CARE
GA743055533OtherLST HEALTH
GA182686OtherCOVENTRY
GA52450038OtherBLUE CROSS
GA743055533OtherPHCS
GA743055533Other743055533
GA10659984294OtherHUMANA
GA743055533OtherHEALTHSTAR
GA743055533OtherONE HEALTH
GA743055533OtherCCN
GA11BDWFRMedicare ID - Type Unspecified
GA00282675BMedicaid