Provider Demographics
NPI:1578666780
Name:STEFANIS, GEORGE S (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:S
Last Name:STEFANIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 HOSPITAL DR STE 205
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-8025
Mailing Address - Country:US
Mailing Address - Phone:478-741-3690
Mailing Address - Fax:
Practice Address - Street 1:310 HOSPITAL DR STE 205
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-8025
Practice Address - Country:US
Practice Address - Phone:478-741-3690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023409207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00239577BMedicaid
GA5752930001Medicare NSC
GA00239577BMedicaid
GA$$$$$$$$$BMedicare PIN