Stillwagon, Gary
Stillwagon, Gary is an individual health care provider with primary practice located at 698 Duluth Hwy Suite 100, Lawrenceville GA 30046-7645. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Radiation Oncology. Allopathic & Osteopathic Physicians / Radiation Oncology is his primary health care specialty. Stillwagon, Gary can be contacted via phone (770) 962-8888.Contact Information
Primary practice address
698 Duluth Hwy Suite 100
Lawrenceville GA 30046-7645
Phone: (770) 962-8888
Fax: (770) 963-7447
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 035774 | Georgia |
| Allopathic & Osteopathic Physicians / Radiation Oncology | 2085R0001X | 035774 | Georgia |
Profile Details
| NPI number | 1548244817 |
|---|---|
| LBN Legal business name | Stillwagon, Gary |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 1st, 2005 |
| Last updated | Jul 13th, 2015 - about 10 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1548244817 | NPPES |
| Georgia | MEDICAID | 000582524H | |
| Georgia | MEDICAID | 000582524J |
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