Provider Demographics
NPI:1881876126
Name:IGOR STOJANOV,MD,PC
Entity type:Organization
Organization Name:IGOR STOJANOV,MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-210-2626
Mailing Address - Street 1:3623 J DEWEY GRAY CIR
Mailing Address - Street 2:SUITE 430
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6511
Mailing Address - Country:US
Mailing Address - Phone:706-210-2626
Mailing Address - Fax:706-210-2799
Practice Address - Street 1:3623 J DEWEY GRAY CIR
Practice Address - Street 2:SUITE 430
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6511
Practice Address - Country:US
Practice Address - Phone:706-210-2626
Practice Address - Fax:706-210-2799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0525112084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA462916545AMedicaid
GA13BDDRHOtherMEDICARE ID#
SCG52511Medicaid
GAG73495Medicare UPIN