Provider Demographics
NPI:1043245939
Name:STORY, STACY HAMMOND III (MD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:HAMMOND
Last Name:STORY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 CUMMING RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4335
Mailing Address - Country:US
Mailing Address - Phone:706-829-3516
Mailing Address - Fax:706-733-8044
Practice Address - Street 1:501 BLACKBURN DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-8201
Practice Address - Country:US
Practice Address - Phone:706-854-8340
Practice Address - Fax:706-854-8388
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017559207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA050045947OtherRAILROAD MEDICARE
SC907941Medicaid
GA000151159CMedicaid
GA000151159CMedicaid
GA05BDDXRMedicare PIN