Provider Demographics
NPI:1467281287
Name:STOLER, MARCIA WYNN (RDH)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:WYNN
Last Name:STOLER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N. WESTOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707
Mailing Address - Country:US
Mailing Address - Phone:229-405-6249
Mailing Address - Fax:229-329-4373
Practice Address - Street 1:LEE HEALTH CENTER
Practice Address - Street 2:118 ROBERT B. LEE DR
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763
Practice Address - Country:US
Practice Address - Phone:229-759-6508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH004242124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist