Healthcare Provider Details

I. General information

NPI: 1245967322
Provider Name (Legal Business Name): ASHLEY CHRISTINA STEPANEK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 OLD MILTON PKWY STE C270
ALPHARETTA GA
30005-4414
US

IV. Provider business mailing address

115 SUNNYBROOK LN
WOODSTOCK GA
30188-1800
US

V. Phone/Fax

Practice location:
  • Phone: 770-442-1911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number1197464
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: