Provider Demographics
NPI:1013071414
Name:LITTLE, CECIL STEPHEN (DO)
Entity Type:Individual
Prefix:
First Name:CECIL
Middle Name:STEPHEN
Last Name:LITTLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2278 MOODY RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-3247
Mailing Address - Country:US
Mailing Address - Phone:478-928-0294
Mailing Address - Fax:478-923-9770
Practice Address - Street 1:2278 MOODY RD
Practice Address - Street 2:SUITE D
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-3247
Practice Address - Country:US
Practice Address - Phone:478-928-0294
Practice Address - Fax:478-923-9770
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0356842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000612356AMedicaid
GA26BDFNVMedicare ID - Type Unspecified