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Individual
MICKEY DWIGHT STAPP
Active
Individual
MICKEY DWIGHT STAPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
POD000728
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000660635H
—
GA
05
—
000660635J
—
GA
05
—
000660635R
—
GA
01
—
2700036
UNITED HEALTHCARE
GA
01
—
480032189
RAILROAD MEDICARE
GA
01
—
5106049
AETNA PPO
GA
01
—
555655
BCBS OF GEORGIA
GA
01
—
575733
AETNA HMO
GA
01
—
GDP728
SOUTH CAROLINA MEDICAID
SC
05
—
GPD728
—
SC
Enumeration date
09/15/2006
Last updated
08/26/2025
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