Individual
ROURKE M STAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
717 20TH ST, COLUMBUS, GA 31902-2787
(706) 653-0292
(706) 653-1162
Mailing address
PO BOX 370, FORTSON, GA 31808-0370
(706) 494-3008
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0101240371
VA
2085R0202X
Diagnostic Radiology Physician
Primary
064432
GA
2085R0202X
Diagnostic Radiology Physician
A108438
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202G707915
GROUP NUMBER FOR CDC ON COMER
GA
01
—
P00882634
RR MEDICARE
GA
Enumeration date
05/21/2007
Last updated
06/04/2020
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