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Individual

MR. KENNETH CRAIG STALLINGS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
L..O.

Contact information

Practice address
5801 BLUE RIDGE DR, BLUE RIDGE, GA 30513-3245
(706) 632-0384
Mailing address
270 GUNITE CIR, #9251, ELLIJAY, GA 30540-6453
(706) 669-2386

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
00013
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003128965A
GA
Enumeration date
11/17/2006
Last updated
02/15/2013
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