Healthcare Provider Details

I. General information

NPI: 1275575540
Provider Name (Legal Business Name): STEPHANIE H. RESNICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993 JOHNSON FERRY RD STE D100
ATLANTA GA
30342
US

IV. Provider business mailing address

1266 W PACES FERRY RD NW STE 652
ATLANTA GA
30327-2306
US

V. Phone/Fax

Practice location:
  • Phone: 404-303-4625
  • Fax:
Mailing address:
  • Phone: 678-802-9088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number234678
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number061511
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number061511
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: