Individual
PRISCILLA RUTH STROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
725 JESSE JEWELL PKWY SE, GAINESVILLE, GA 30501-3834
(770) 536-2323
(770) 536-4947
Mailing address
PO BOX 658, GAINESVILLE, GA 30503-0658
(770) 718-1122
(770) 535-7445
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
021053
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000221955H
PEACH STATE
GA
05
—
000221955H
—
GA
05
—
000221955J
—
GA
01
—
01050059
AMERIGROUP
GA
01
—
1177000
UHC
GA
01
—
1415794
CIGNA
GA
01
—
343257
WELLCARE
GA
01
—
5151005
AETNA
GA
01
—
52476028
BCBS
GA
01
—
572604
COVENTRY
GA
01
—
P00434214
MEDICARE RAILROAD
GA
Enumeration date
05/27/2005
Last updated
03/08/2019
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