Provider Demographics
NPI:1912995119
Name:STAPLETON, SIDNEY LAWSON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:LAWSON
Last Name:STAPLETON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2665 N DECATUR RD STE 130
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6136
Mailing Address - Country:US
Mailing Address - Phone:404-501-7081
Mailing Address - Fax:404-419-1680
Practice Address - Street 1:2665 N DECATUR RD STE 130
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-501-7081
Practice Address - Fax:404-419-1680
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA011485208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00111757CMedicaid
GA02BDFPDMedicare ID - Type Unspecified
GA00111757CMedicaid