Provider Demographics
NPI:1821152083
Name:STOJANOV, IGOR (MD)
Entity Type:Individual
Prefix:DR
First Name:IGOR
Middle Name:
Last Name:STOJANOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3623 J DEWEY GRAY CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6511
Mailing Address - Country:US
Mailing Address - Phone:706-210-2626
Mailing Address - Fax:706-210-2799
Practice Address - Street 1:3623 J DEWEY GRAY CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6511
Practice Address - Country:US
Practice Address - Phone:706-210-2626
Practice Address - Fax:706-210-2799
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0525112084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG52511Medicaid
GA462916545DMedicaid
GA511I130024Medicare PIN