Provider Demographics
NPI:1710920657
Name:STEVICK, JAMES ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALLEN
Last Name:STEVICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:575 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2825
Mailing Address - Country:US
Mailing Address - Phone:478-743-9762
Mailing Address - Fax:478-746-6612
Practice Address - Street 1:4519 WOODRUFF RD STE 17
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6091
Practice Address - Country:US
Practice Address - Phone:706-221-8999
Practice Address - Fax:706-221-8809
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034481208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF87770Medicare UPIN
GA0200514769OtherRAIL ROAD
GA00616217FMedicaid