Stanley M Tenenbaum, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

011493 Issued in GA

Practice address

1805 Parke Plaza Cir
Ste 103
Stone Mountain, GA 30087

Phone

(770) 498-9355

Fax

(770) 498-6294

NPI assigned

May 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Northlake Pediatric Associates,PC

  • Pediatrics Physician
  • Stone Mountain, GA
  • NPI 1518174036
  NPD (past)

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

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389312000000",
    "number": "1316998255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 PARKE PLAZA CIR",
            "address_2": "STE 103",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "30087",
            "telephone_number": "770-498-9355",
            "fax_number": "770-498-6294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 PARKE PLAZA CIR",
            "address_2": "STE 103",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "30087",
            "telephone_number": "770-498-9355",
            "fax_number": "770-498-6294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TENENBAUM",
        "first_name": "STANLEY",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-15",
        "last_updated": "2014-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "011493",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00568972A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brenda Dawne Telford, D.O.
• Ten 2 Speech & Language Therapy, LLC
• Marshet Tenaw
• Tender Care Services, LLC
• Tender Touch Health Care Services
• Tassew Tesfaye, M.D.
• The Art of Living Cla LLC.
• The Atlanta Medical Speech Pathology Group
• The Back Shack LLC
• The Boone Clinic, P.C.

• Pediatrics Physician in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.