Healthcare Provider Details

I. General information

NPI: 1548525751
Provider Name (Legal Business Name): STEPHEN S. LAW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 DONALD LEE HOLLOWELL PKWY NW
ATLANTA GA
30318-6653
US

IV. Provider business mailing address

2976 RIVERMEADE DR NW
ATLANTA GA
30327-2012
US

V. Phone/Fax

Practice location:
  • Phone: 404-523-6571
  • Fax:
Mailing address:
  • Phone: 404-352-8125
  • Fax: 404-352-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number20881
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: