Provider Demographics
NPI:1356307441
Name:STONE, FREDERICK C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:C
Last Name:STONE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:115 N SUMTER ST STE 400
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4971
Practice Address - Country:US
Practice Address - Phone:803-774-7425
Practice Address - Fax:803-774-9426
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ34255207Q00000X
LA10855768207Q00000X
SC81570207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC815700Medicaid
AZ965957Medicaid
AZ965957Medicaid