Provider Demographics
NPI:1457315491
Name:PRATHER, STUART H III (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:H
Last Name:PRATHER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1125 TROUPE ST
Mailing Address - Street 2:P.O. BOX 3845
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30914-3845
Mailing Address - Country:US
Mailing Address - Phone:706-737-4575
Mailing Address - Fax:706-731-5289
Practice Address - Street 1:4350 TOWNE CENTRE DR
Practice Address - Street 2:SUITE 1000
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3301
Practice Address - Country:US
Practice Address - Phone:706-868-3940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0276352085R0202X, 2085D0003X, 2085B0100X, 2085N0700X, 2085N0904X, 2085P0229X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00344341GMedicaid
GA00344341IMedicaid
10059162OtherAMERIGROUP
SCG27635Medicaid
GA00344341PMedicaid
GA00344341CMedicaid
GA00344341MMedicaid
GA00344341KMedicaid
1265540314OtherNPI - BROWN & RADIOLOGY
GA00344341FMedicaid
GA003443417JMedicaid
GA00344341HMedicaid
GA00344341NMedicaid
GA00344341EMedicaid
GA00344341NMedicaid
GA300074339Medicare PIN
1265540314OtherNPI - BROWN & RADIOLOGY
GA00344341CMedicaid
GA00344341EMedicaid