Provider Demographics
NPI:1679890594
Name:STEGALL, JONATHAN DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DANIEL
Last Name:STEGALL
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3333 OLD MILTON PKWY STE 560
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4437
Mailing Address - Country:US
Mailing Address - Phone:770-551-2730
Mailing Address - Fax:770-551-2731
Practice Address - Street 1:3333 OLD MILTON PKWY STE 560
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4437
Practice Address - Country:US
Practice Address - Phone:770-551-2730
Practice Address - Fax:770-551-2731
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA069967207R00000X
GA69967207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine