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Individual

RICHARD JOHN STAIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.A.

Contact information

Practice address
8954 HOSPITAL DR, DOUGLASVILLE, GA 30134-2272
(770) 920-6413
(678) 838-2532
Mailing address
610 ACADIA DR # 7131, ELLIJAY, GA 30540-5986
(770) 634-1287

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
003918
GA
367H00000X
Anesthesiologist Assistant
Primary
003918
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100002432B
GA
05
491431789A
GA
Enumeration date
11/17/2005
Last updated
05/29/2013
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