Provider Demographics
NPI:1801159876
Name:STEMBRIDGE, WILLIAM DAVID (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DAVID
Last Name:STEMBRIDGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4 LIVE OAK CT
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-6783
Mailing Address - Country:US
Mailing Address - Phone:229-785-2400
Mailing Address - Fax:229-890-8743
Practice Address - Street 1:4 LIVE OAK CT
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768
Practice Address - Country:US
Practice Address - Phone:229-785-2400
Practice Address - Fax:229-890-9743
Is Sole Proprietor?:No
Enumeration Date:2012-06-24
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA080936208600000X, 208600000X
MDH83585208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD458905000Medicaid
MD595458Y5ZOtherMEDICARE