Provider Demographics
NPI:1083021281
Name:STINSON, FRED III
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:
Last Name:STINSON
Suffix:III
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 1:414 ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-3847
Mailing Address - Country:US
Mailing Address - Phone:478-274-0036
Mailing Address - Fax:478-274-0036
Practice Address - Street 1:414 ALLEN DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3847
Practice Address - Country:US
Practice Address - Phone:478-274-0036
Practice Address - Fax:478-274-0036
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-20
Last Update Date:2014-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1567101YA0400X
GA007333101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)