Provider Demographics
NPI:1174693931
Name:STUBBLEFIELD, JON ERIC (PA)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:ERIC
Last Name:STUBBLEFIELD
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:192 LINDQUIST RD
Mailing Address - Street 2:BUILDING 412
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314
Mailing Address - Country:US
Mailing Address - Phone:912-435-5457
Mailing Address - Fax:
Practice Address - Street 1:1110 W PEACHTREE ST NW STE 940
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3609
Practice Address - Country:US
Practice Address - Phone:770-292-6500
Practice Address - Fax:770-292-6535
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2018-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY009452-1363AM0700X
GA005200363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical