Provider Demographics
NPI:1154410538
Name:STONE, JEFFREY CRAIG (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:CRAIG
Last Name:STONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 COBB PARKWAY NORTH NW STE 201A
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4182
Mailing Address - Country:US
Mailing Address - Phone:770-974-4655
Mailing Address - Fax:770-974-1970
Practice Address - Street 1:1495 HICKORY FLAT HWY STE 100
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-4266
Practice Address - Country:US
Practice Address - Phone:678-341-6360
Practice Address - Fax:678-626-7900
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164682207Q00000X
GA062611207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00933766Medicaid
NYCC9410Medicare PIN
NYE78904Medicare UPIN