1629087341 NPI number — DR. JOHN H STEPHENSON M.D.

Table of content: DR. JOHN H STEPHENSON M.D. (NPI 1629087341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629087341 NPI number — DR. JOHN H STEPHENSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEPHENSON
Provider First Name:
JOHN
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629087341
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5671 PEACHTREE DUNWOODY RD NE
Provider Second Line Business Mailing Address:
SUITE 610
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30342-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-257-1415
Provider Business Mailing Address Fax Number:
404-851-1649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5665 PEACHTREE DUNWOODY RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342-1701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-851-7324
Provider Business Practice Location Address Fax Number:
404-843-2627
Provider Enumeration Date:
08/05/2006

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: 207L00000X , with the licence number:  036018 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LC0200X , with the licence number: 036018 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: 036018 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000516579L , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00516579D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".