Provider Demographics
NPI:1932307923
Name:WILLIAM C STOLL LLC
Entity Type:Organization
Organization Name:WILLIAM C STOLL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:STOLL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:404-355-4522
Mailing Address - Street 1:3193 HOWELL MILL RD NW
Mailing Address - Street 2:SUITE 326
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2119
Mailing Address - Country:US
Mailing Address - Phone:404-355-4522
Mailing Address - Fax:404-355-4512
Practice Address - Street 1:3193 HOWELL MILL RD NW
Practice Address - Street 2:SUITE 326
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2119
Practice Address - Country:US
Practice Address - Phone:404-355-4522
Practice Address - Fax:404-355-4512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000947213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU96578Medicare UPIN
GA4960550001Medicare NSC
GAGRP6059Medicare PIN