Individual
MR. DAVID E STIDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FPMHNP
Contact information
Practice address
1905 S HUTCHINSON AVE, ADEL, GA 31620-5246
(229) 896-4559
(229) 896-8367
Mailing address
3120 N OAK STREET EXT STE C, VALDOSTA, GA 31602-5910
(229) 896-4559
(229) 896-8367
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
RN139536
GA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN139536
GA
Other
Enumeration date
06/01/2018
Last updated
09/27/2021
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