Provider Demographics
NPI:1326175738
Name:PIRKLE, STEPHANIE SPAULDING (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SPAULDING
Last Name:PIRKLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:SPAULDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1575 CHATTANOOGA AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2672
Mailing Address - Country:US
Mailing Address - Phone:706-876-2130
Mailing Address - Fax:
Practice Address - Street 1:1575 CHATTANOOGA AVE STE 1
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2672
Practice Address - Country:US
Practice Address - Phone:706-876-2130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200600921208000000X
TN0000042232208000000X
GA063431208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404481Medicaid
GA660561309AMedicaid