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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 11 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.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1548244817 NPPES
Georgia MEDICAID 000582524H
Georgia MEDICAID 000582524J

Popular Providers