Provider Demographics
NPI:1033263314
Name:STUCKEY, ORVILLE JR (DO)
Entity Type:Individual
Prefix:DR
First Name:ORVILLE
Middle Name:
Last Name:STUCKEY
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2557 HIGHWAY 76
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-7311
Mailing Address - Country:US
Mailing Address - Phone:706-517-0419
Mailing Address - Fax:706-517-0420
Practice Address - Street 1:2557 HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-7311
Practice Address - Country:US
Practice Address - Phone:706-517-0419
Practice Address - Fax:706-517-0420
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCJHVMedicare PIN
GAV00870Medicare UPIN