Individual
SHAD ASHTON STORMANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1302 PLANT AVE, WAYCROSS, GA 31501-3537
(912) 490-5080
(912) 490-5081
Mailing address
1302 PLANT AVE, WAYCROSS, GA 31501-3537
(912) 490-5080
(912) 490-5081
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
079703
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
GA
Other
Enumeration date
09/05/2012
Last updated
09/28/2022
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