Healthcare Provider Details

I. General information

NPI: 1548869506
Provider Name (Legal Business Name): STEPHANIE REGINE GARBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE REGINE GREEN

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 12/14/2021
Certification Date: 12/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S MAIN ST STE C7
ALPHARETTA GA
30009-7960
US

IV. Provider business mailing address

401 S MAIN ST STE C7
ALPHARETTA GA
30009-7960
US

V. Phone/Fax

Practice location:
  • Phone: 678-319-9901
  • Fax: 678-319-9902
Mailing address:
  • Phone: 678-319-9901
  • Fax: 678-319-9902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number217090
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: