Provider Demographics
NPI:1861945636
Name:STARK, TIMOTHY T
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:T
Last Name:STARK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 HILLANDALE DR
Mailing Address - Street 2:STE 145
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-4840
Mailing Address - Country:US
Mailing Address - Phone:678-418-8072
Mailing Address - Fax:678-518-0137
Practice Address - Street 1:6000 HILLANDALE DR
Practice Address - Street 2:STE 145
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4840
Practice Address - Country:US
Practice Address - Phone:678-418-8072
Practice Address - Fax:678-518-0137
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist