Provider Demographics
NPI:1578549721
Name:STUBBS, MARIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:STUBBS
Suffix:
Gender:F
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:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38557-0727
Mailing Address - Country:US
Mailing Address - Phone:931-456-0881
Mailing Address - Fax:931-456-1511
Practice Address - Street 1:189 LANTANA RD
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4902
Practice Address - Country:US
Practice Address - Phone:931-456-0881
Practice Address - Fax:931-456-1511
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41045207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G48181Medicare UPIN
TN3068542Medicare ID - Type Unspecified