Individual
DR. GARY STILLWAGON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
698 DULUTH HWY, SUITE 100, LAWRENCEVILLE, GA 30046-7645
(770) 962-8888
(770) 963-7447
Mailing address
PO BOX 116470, ATLANTA, GA 30368-6470
(404) 320-1550
(404) 728-1081
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
035774
GA
2085R0001X
Radiation Oncology Physician
Primary
035774
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000582524H
—
GA
05
—
000582524J
—
GA
Enumeration date
12/01/2005
Last updated
07/13/2015
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