Provider Demographics
NPI:1598904500
Name:ERCEG, STEFAN KENNETH (MBBS)
Entity type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:KENNETH
Last Name:ERCEG
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1380 MILSTEAD AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012
Mailing Address - Country:US
Mailing Address - Phone:770-388-7745
Mailing Address - Fax:770-922-0526
Practice Address - Street 1:1380 MILSTEAD AVE
Practice Address - Street 2:SUITE G
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012
Practice Address - Country:US
Practice Address - Phone:770-388-7745
Practice Address - Fax:770-922-0526
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2016-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA64371174400000X, 207L00000X, 208VP0014X
TNMD0000045009208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine