Provider Demographics
NPI:1023498938
Name:STAGGS, EMILY (DO)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:STAGGS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:840 W FLOYD BAKER BLVD
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341
Practice Address - Country:US
Practice Address - Phone:864-489-3300
Practice Address - Fax:864-488-3744
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37664207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC376649Medicaid
SCSCD4416067OtherMEDICARE PIN
SCSCD4416121OtherMEDICARE PIN
SCSCD441J577OtherMEDICARE PIN