Provider Demographics
NPI:1689643488
Name:CECIL, STEPHEN G (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:G
Last Name:CECIL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 465687
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30042-5687
Mailing Address - Country:US
Mailing Address - Phone:770-237-1089
Mailing Address - Fax:770-237-1124
Practice Address - Street 1:1727 W NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-8114
Practice Address - Country:US
Practice Address - Phone:919-736-7908
Practice Address - Fax:770-237-1124
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NC28009207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC68575Medicare UPIN