Provider Demographics
NPI:1104100916
Name:STONE, FABIAN A
Entity type:Individual
Prefix:
First Name:FABIAN
Middle Name:A
Last Name:STONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PERIMETER PARK DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1334
Mailing Address - Country:US
Mailing Address - Phone:479-201-8212
Mailing Address - Fax:866-828-7724
Practice Address - Street 1:30 PERIMETER PARK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-1334
Practice Address - Country:US
Practice Address - Phone:479-201-8212
Practice Address - Fax:866-828-7724
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician