Provider Demographics
NPI:1881621142
Name:STUCKEY, WESLEY MABRY (MD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:MABRY
Last Name:STUCKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1525 CHATTANOOGA RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8379
Mailing Address - Country:US
Mailing Address - Phone:706-226-3373
Mailing Address - Fax:706-226-0845
Practice Address - Street 1:1525 CHATTANOOGA RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8379
Practice Address - Country:US
Practice Address - Phone:706-226-3373
Practice Address - Fax:706-226-0845
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036620207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00544321AMedicaid
GA00544321AMedicaid
GAE84713Medicare UPIN