Provider Demographics
NPI:1073718664
Name:STONE SURGERY CLINIC
Entity Type:Organization
Organization Name:STONE SURGERY CLINIC
Other - Org Name:FAWAZ MEDICAL & SURGICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-951-4638
Mailing Address - Street 1:4417 US HWY 331 S
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32435-6703
Mailing Address - Country:US
Mailing Address - Phone:850-951-4638
Mailing Address - Fax:850-951-4554
Practice Address - Street 1:4417 US HWY 331 S
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-6703
Practice Address - Country:US
Practice Address - Phone:850-951-4638
Practice Address - Fax:850-951-4554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3024682363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty