Provider Demographics
NPI:1447286000
Name:GRYBOSKI, STACY STEIN (MD)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:STEIN
Last Name:GRYBOSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1161 OAKDALE RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1284
Mailing Address - Country:US
Mailing Address - Phone:404-370-1551
Mailing Address - Fax:404-370-4145
Practice Address - Street 1:59 EXECUTIVE PARK SOUTH NE
Practice Address - Street 2:4TH FLOOR - RADIOLOGY IMAGING
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2208
Practice Address - Country:US
Practice Address - Phone:404-778-5834
Practice Address - Fax:404-778-7015
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA407982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology