Provider Demographics
NPI:1316998255
Name:TENENBAUM, STANLEY M (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:M
Last Name:TENENBAUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1805 PARKE PLAZA CIR
Mailing Address - Street 2:STE 103
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087
Mailing Address - Country:US
Mailing Address - Phone:770-498-9355
Mailing Address - Fax:770-498-6294
Practice Address - Street 1:1805 PARKE PLAZA CIR
Practice Address - Street 2:STE 103
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087
Practice Address - Country:US
Practice Address - Phone:770-498-9355
Practice Address - Fax:770-498-6294
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA011493208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00568972AMedicaid