Provider Demographics
NPI:1558368415
Name:STOLOVITZKY, JOSE PABLO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:PABLO
Last Name:STOLOVITZKY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5673 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:STE 150
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1731
Mailing Address - Country:US
Mailing Address - Phone:404-297-1780
Mailing Address - Fax:404-252-7255
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD
Practice Address - Street 2:STE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1731
Practice Address - Country:US
Practice Address - Phone:404-297-1780
Practice Address - Fax:404-252-7255
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2017-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA029536207Y00000X, 207YS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000442714ATMedicaid
GA3969952OtherCIGNA
GA000442714AQMedicaid
GA52530801OtherBCBS OF GEORGIA
GA000442714AGMedicaid
GA400117110OtherRAILROAD MEDICARE
GA4134024OtherAETNA
GA202I043912Medicare PIN
GA000442714AQMedicaid