Provider Demographics
NPI:1124014022
Name:PANCER, STUART J (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:J
Last Name:PANCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2199 COLLEGE AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-1334
Mailing Address - Country:US
Mailing Address - Phone:770-396-2496
Mailing Address - Fax:770-493-6189
Practice Address - Street 1:2199 COLLEGE AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-1334
Practice Address - Country:US
Practice Address - Phone:770-396-2496
Practice Address - Fax:770-493-6189
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040187207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00657401DMedicaid
GA16BDGHH02Medicare PIN
GA160038534Medicare PIN
GAG05403Medicare UPIN