Provider Demographics
NPI:1801885934
Name:STAHURA, DAVID ALAN (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:STAHURA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2140 PEACHTREE RD NW STE 232
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1316
Mailing Address - Country:US
Mailing Address - Phone:404-231-4431
Mailing Address - Fax:404-231-5677
Practice Address - Street 1:2140 PEACHTREE RD NW STE 232
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1316
Practice Address - Country:US
Practice Address - Phone:404-231-4431
Practice Address - Fax:404-231-5677
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060615207Q00000X
OH34003002207Q00000X
GA032036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA155088371AMedicaid
OH080176229OtherRAILROAD MCR
OH341773700028OtherCARESOURCE
OH000000030548OtherANTHEM
OH0426444Medicaid
202I085401Medicare PIN
GA202I085401Medicare PIN
OH080176229OtherRAILROAD MCR
OH000000030548OtherANTHEM
GAST0477041Medicare PIN