Provider Demographics
NPI:1437167186
Name:STOCKBRIDGE INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:STOCKBRIDGE INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VALLIKKAT
Authorized Official - Middle Name:T
Authorized Official - Last Name:GIRIJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-507-4414
Mailing Address - Street 1:1500 ROCK QUARRY ROAD
Mailing Address - Street 2:MAILING: PO BOX 2489
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-8925
Mailing Address - Country:US
Mailing Address - Phone:770-504-4414
Mailing Address - Fax:770-507-4415
Practice Address - Street 1:1500 ROCK QUARRY ROAD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-8925
Practice Address - Country:US
Practice Address - Phone:770-507-4414
Practice Address - Fax:770-507-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDKTSMedicare ID - Type UnspecifiedMEDICARE PROVIDER