Provider Demographics
NPI:1811516891
Name:G. CLARK STULL, DC PC
Entity type:Organization
Organization Name:G. CLARK STULL, DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-474-2344
Mailing Address - Street 1:2169 INGLESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2029
Mailing Address - Country:US
Mailing Address - Phone:478-474-2344
Mailing Address - Fax:478-746-0262
Practice Address - Street 1:2169 INGLESIDE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2029
Practice Address - Country:US
Practice Address - Phone:478-474-2344
Practice Address - Fax:478-746-0262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty