| Doctor Name: | DR. STEFAN KENNETH ERCEG |
| NPI Number: | 1598904500 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.B.B.S. |
| License Number: | 64371 |
| Business Practice Address: | 1321 Interstate Pkwy Augusta, GA - 309095626 |
| Business Phone Number: | 7067387246 |
| Business Fax Number: | 7069229328 |
| Mailing Address: | Po Box 102783, ATLANTA |
| State: | GA |
| Postal Code: | 303682783 |
| Phone Number: | 7065433449 |
| Fax Number: | 7065435744 |
| NPI Enumeration Date: | 02/13/2009 |
| NPI Last Update Date: | 03/27/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 64371 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |