Stillwater South LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

STILLWATER SOUTH LLC

Practice address

553 Stover Rd
Canton, GA 30115-4508

Phone

(503) 791-3205

NPI assigned

Feb 3, 2022

Organization subpart

No

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

Authorized official

Name

Mr. Nicholas Mathews

Title

Ceo

Phone

(503) 791-3205

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1643846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643846400000",
    "number": "1891449351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4575 WEBB BRIDGE RD",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300054256",
            "telephone_number": "503-791-3205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "553 STOVER RD",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301154508",
            "telephone_number": "503-791-3205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STILLWATER SOUTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-03",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A",
        "authorized_official_last_name": "MATHEWS",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "503-791-3205",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roger Patrick Stewart, D.M.D
• Samantha Rose Stewart, PA-C
• Cameron Jacob Stiglich
• Fei Stiles, PHARMACIST
• Still Waters Family Chiropractic, LLC
• Kara Stinehart, FNP
• Ansley Stone
• Jeffrey Craig Stone, MD
• Jessica Stouffer, MSW, LMSW
• Barry Neil Straus, M.D.

• Substance Abuse Rehabilitation Facility in Canton, GA
• Providers in Canton, GA by specialty
• Substance Abuse Rehabilitation Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; 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.