Individual provider Active NPI

Micah Stuman

  • Physical Medicine & Rehabilitation Physician
  • Lawrenceville, GA
National Provider Identifier
1265267371
Registry record updated Sep 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
PT017369 Issued in GA
Practice address
758 Old Norcross Rd Ste 100
Lawrenceville, GA 30046-3386
Phone
(770) 962-4300
NPI assigned
Sep 6, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X PT017369 GA Primary

Addresses

Primary practice location

758 Old Norcross Rd Ste 100
Lawrenceville, GA 30046-3386

Mailing address

4025 McGinnis Ferry Rd Apt 510
Suwanee, GA 30024-8323
Phone (770) 722-1813

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241206000053 GA Practitioner - Physical Therapist in Private Practice 9234665852 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT017369GAMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Resurgens, LLC CurrentSince Sep 23, 2024 Accepting new patients
Resurgens, LLC CurrentSince Sep 23, 2024 Accepting new patients

Locations

2041 Mesa Valley Way
Ste 100
Austell, GA 30106
Phone (770) 944-1100

758 Old Norcross Rd
Ste 175
Lawrenceville, GA 30046
Phone (770) 339-1387

758 Old Norcross Rd
Ste 100
Lawrenceville, GA 30046
Phone (770) 962-4300

5671 Ptree Dunwoody Rd NE
Ste 700
Sandy Springs, GA 30342
Phone (404) 459-3732

5671 Ptree Dunwoody Rd NE
Ste 900
Sandy Springs, GA 30342
Phone (404) 531-8590

Interoperability endpoints

  • Direct secure messaging: micah.stuman.1@15749.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1725580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1265267371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4025 MCGINNIS FERRY RD APT 510",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300248323",
            "telephone_number": "770-722-1813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "758 OLD NORCROSS RD STE 100",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463386",
            "telephone_number": "770-962-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUMAN",
        "first_name": "MICAH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-06",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "GA",
            "license": "PT017369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.