Individual
STEPHEN JOHN KLACIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
725 JESSE JEWELL PKWY SE, GAINESVILLE, GA 30501-3834
(770) 535-3611
(770) 535-7092
Mailing address
PO BOX 658, GAINESVILLE, GA 30503-0658
(770) 718-1122
(770) 535-7445
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
054230
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10032998
AMERIGROUP
GA
01
—
1908730
UHC
GA
01
—
302568
WELLCARE
GA
01
—
302579
WELLCARE
GA
01
—
302580
WELLCARE
GA
01
—
302581
WELLCARE
GA
01
—
3532508
AETNA HMO
GA
01
—
3548885
CIGNA
GA
01
—
52703273
BCBS
GA
01
—
5779768
AETNA PPO
GA
05
—
845371853A
—
GA
05
—
845371853B
—
GA
05
—
845371853C
—
GA
05
—
845371853D
—
GA
05
—
845371853F
—
GA
Enumeration date
01/20/2006
Last updated
08/17/2023
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