Provider Demographics
NPI:1700380003
Name:STUBBS, CHIVON (MD)
Entity Type:Individual
Prefix:
First Name:CHIVON
Middle Name:
Last Name:STUBBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHIVON
Other - Middle Name:V
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:720 WESTVIEW DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-1458
Mailing Address - Country:US
Mailing Address - Phone:044-752-1000
Mailing Address - Fax:
Practice Address - Street 1:1401 HOSEA WILLIAMS DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-1703
Practice Address - Country:US
Practice Address - Phone:404-373-6614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA87681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine