Provider Demographics
NPI:1801904354
Name:STONECIPHER, MARCUS R (MD)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:R
Last Name:STONECIPHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 CLAIRMONT RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3415
Mailing Address - Country:US
Mailing Address - Phone:404-321-4600
Mailing Address - Fax:404-320-0987
Practice Address - Street 1:1951 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3415
Practice Address - Country:US
Practice Address - Phone:404-321-4600
Practice Address - Fax:404-320-0987
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037087207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00543144AMedicaid
GA00543144AMedicaid
E90041Medicare UPIN