Individual
CAROLINE M STACKHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1035 RED BUD RD NE, CALHOUN, GA 30701-2082
(706) 629-2895
Mailing address
PO BOX 635232, CINCINNATI, OH 45263-0001
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
042898
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000744235K
—
GA
01
—
P00333881
RAILROAD MEDICARE
GA
Enumeration date
08/13/2006
Last updated
10/09/2012
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