Provider Demographics
NPI:1477591675
Name:STUBBS, MIGUEL E (MD,PC)
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:E
Last Name:STUBBS
Suffix:
Gender:M
Credentials:MD,PC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3330 S COBB DR SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4128
Mailing Address - Country:US
Mailing Address - Phone:678-556-9460
Mailing Address - Fax:678-556-9462
Practice Address - Street 1:3001 S COBB DR SE
Practice Address - Street 2:SUITE 103
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7809
Practice Address - Country:US
Practice Address - Phone:678-556-9460
Practice Address - Fax:678-556-9462
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2017-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA037708207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00603006IMedicaid
GA00603006IMedicaid