Provider Demographics
NPI:1649598277
Name:SMILJKA STOJANOVIC MD, LLC
Entity Type:Organization
Organization Name:SMILJKA STOJANOVIC MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SMILJKA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOJANOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-924-8001
Mailing Address - Street 1:206 REES ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3753
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:206 REES ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3753
Practice Address - Country:US
Practice Address - Phone:229-924-8001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003105027AMedicaid
GA102G111530OtherMEDICARE PTAN