Healthcare Provider Details

I. General information

NPI: 1669309977
Provider Name (Legal Business Name): STEPHANIE RENEE'S SALON AND MED SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N HUTCHINSON AVE
ADEL GA
31620-2344
US

IV. Provider business mailing address

301 N HUTCHINSON AVE
ADEL GA
31620-2344
US

V. Phone/Fax

Practice location:
  • Phone: 229-507-9102
  • Fax:
Mailing address:
  • Phone: 229-507-9102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE RENEE MILLER
Title or Position: OWNER/CEO
Credential: RN
Phone: 229-507-9102