Provider Demographics
NPI:1285621110
Name:PLAVIN, STANFORD R (MD)
Entity type:Individual
Prefix:
First Name:STANFORD
Middle Name:R
Last Name:PLAVIN
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 1:438 TARA TRL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4926
Mailing Address - Country:US
Mailing Address - Phone:404-242-6360
Mailing Address - Fax:404-549-2853
Practice Address - Street 1:5825 GLENRIDGE DRIVE, BUILDING 3
Practice Address - Street 2:SUITE 101-123
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3032
Practice Address - Country:US
Practice Address - Phone:404-242-6360
Practice Address - Fax:404-549-2853
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH17526207L00000X
CAG136300207L00000X
GA39201207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000635599CMedicaid
GA000635599GMedicaid
GA000635599LMedicaid
GA000635599EMedicaid
GA000635599NMedicaid
GA000635599JMedicaid
GA000635599KMedicaid
GA000635599FMedicaid
GA000635599IMedicaid
GA000635599HMedicaid
GA000635599KMedicaid
GAP00466790Medicare PIN
GA511I050096Medicare PIN
GA000635599FMedicaid