Provider Demographics
NPI:1164751012
Name:MICHAEL B STUBBS MD PC
Entity Type:Organization
Organization Name:MICHAEL B STUBBS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:STUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-292-4348
Mailing Address - Street 1:465 WINN WAY
Mailing Address - Street 2:SUITE 211
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1753
Mailing Address - Country:US
Mailing Address - Phone:404-292-4348
Mailing Address - Fax:404-501-0660
Practice Address - Street 1:465 WINN WAY
Practice Address - Street 2:SUITE 211
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1753
Practice Address - Country:US
Practice Address - Phone:404-292-4348
Practice Address - Fax:404-501-0660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL B STUBBS MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-23
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022652208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000222252AMedicaid
GAD41190Medicare UPIN