Provider Demographics
NPI:1720126329
Name:HIBBS, STANLEY E (PHD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:E
Last Name:HIBBS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7590 HUNTERS WOODS DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-5628
Mailing Address - Country:US
Mailing Address - Phone:770-668-0350
Mailing Address - Fax:770-668-0417
Practice Address - Street 1:1864 INDEPENDENCE SQ
Practice Address - Street 2:SUITE A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-5173
Practice Address - Country:US
Practice Address - Phone:770-668-0350
Practice Address - Fax:770-668-0417
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA572103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00188856DMedicaid
GA00188856DMedicaid