Provider Demographics
NPI:1073500898
Name:STUBBS, MICHAEL BARRY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BARRY
Last Name:STUBBS
Suffix:
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 1:2675 N DECATUR RD
Mailing Address - Street 2:SUITE 710
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6131
Mailing Address - Country:US
Mailing Address - Phone:404-292-4348
Mailing Address - Fax:404-501-0660
Practice Address - Street 1:2675 N DECATUR RD
Practice Address - Street 2:STE 710
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6131
Practice Address - Country:US
Practice Address - Phone:404-292-4348
Practice Address - Fax:404-501-0660
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022652208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000222252AMedicaid
GA000222252AMedicaid