Provider Demographics
NPI:1366463689
Name:BABCOCK, STUART ALVA (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:ALVA
Last Name:BABCOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 ABBINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-5248
Mailing Address - Country:US
Mailing Address - Phone:706-599-6354
Mailing Address - Fax:
Practice Address - Street 1:153 ABBINGTON WAY
Practice Address - Street 2:
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523-5248
Practice Address - Country:US
Practice Address - Phone:706-599-6354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035810208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000516513GMedicaid
GA202I021086Medicare PIN
GA000516513GMedicaid
F40995Medicare UPIN
GA02BBCPTMedicare PIN