# MARY T STAUBLE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1447286414
- **Gender:** F
- **Credential:** PA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 003769 | GA | Yes |

## Other

- **Enumeration date:** 06/23/2006
- **Last updated:** 05/23/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100002095A | — | GU |
| 05 | — | 100002096A | — | GA |
| 05 | — | 100002097A | — | GA |
| 05 | — | 100002786A | — | GA |
| 01 | — | 10059212 | AMERIGROUP | GA |