Stapp, Mickey Dwight

Stapp, Mickey Dwight is an individual health care provider with primary practice located at 1416 Wainbrook Dr , Augusta GA 30909-6289. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as his primary health care specialty. Stapp, Mickey Dwight can be contacted via phone (706) 312-3668.

Contact Information

Primary practice address
1416 Wainbrook Dr Augusta GA 30909-6289
Phone: (706) 312-3668
Fax: (706) 312-3670
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X POD000728 Georgia

Profile Details

NPI number 1023114238
LBN Legal business name Stapp, Mickey Dwight
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 15th, 2006
Last updated Jul 3rd, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023114238 NPPES
Georgia MEDICAID 000660635J
Georgia Other 575733
Georgia Other 2700036
Georgia Other 480032189
Georgia Other 5106049
Georgia Other 555655
Georgia MEDICAID 000660635H
Georgia Other GDP728

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