1013177849 NPI number — REANNE PARRENAS STEPHANSSON M.D.F.A.A.P

Table of content: REANNE PARRENAS STEPHANSSON M.D.F.A.A.P (NPI 1013177849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013177849 NPI number — REANNE PARRENAS STEPHANSSON M.D.F.A.A.P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEPHANSSON
Provider First Name:
REANNE
Provider Middle Name:
PARRENAS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.F.A.A.P
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARRENAS
Provider Other First Name:
REANNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013177849
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11975 MORRIS ROAD
Provider Second Line Business Mailing Address:
STE 210
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-664-0088
Provider Business Mailing Address Fax Number:
770-664-8228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11975 MORRIS ROAD
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
ALPHARETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-664-0088
Provider Business Practice Location Address Fax Number:
770-664-8228
Provider Enumeration Date:
06/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  066084 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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