1164499703 NPI number — STEPHANIE D SINGLETON MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164499703 NPI number — STEPHANIE D SINGLETON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SINGLETON
Provider First Name:
STEPHANIE
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1164499703
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 MARTIN LUTHER KING JR BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31201-3490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-301-2362
Provider Business Mailing Address Fax Number:
478-301-2272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 HARMONY XING STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EATONTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31024-9548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-301-2362
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2006

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: 207VE0102X , with the licence number:  28652 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VG0400X , with the licence number: 61757 , 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)

  • Identifier: PAR . This is a "FIRST HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "VHN/PHCS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010007658 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 73794 . This is a "SENTARA OHP/SHP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2115854 . This is a "UHC/MAMSI/MDIPA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 89066NH , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: PAR . This is a "USA MANAGED CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "AETNA PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "MULTI PLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "MID-ATLANTIC VICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 066NH . This is a "BC/BS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "VPH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: -012 . This is a "CHAMPUS/TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 289608 . This is a "ATHEM BC/BS VA/HK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "CORVEL COR CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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