Provider Demographics
NPI:1730143942
Name:STONE, MONICA RENNER (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:RENNER
Last Name:STONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 S GREEN ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-4618
Mailing Address - Country:US
Mailing Address - Phone:706-647-1803
Mailing Address - Fax:
Practice Address - Street 1:1297 S GREEN ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-4618
Practice Address - Country:US
Practice Address - Phone:706-647-1803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035273174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA930830982AMedicaid
GA16BBCWTMedicare ID - Type Unspecified
GAE84318Medicare UPIN