Healthcare Provider Details

I. General information

NPI: 1982016978
Provider Name (Legal Business Name): GEORGE STEPHENS C.R.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2014
Last Update Date: 05/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 PEACHTREE DUNWOODY RD BLDG 400 STE 125
ATLANTA GA
30328-6773
US

IV. Provider business mailing address

2708 TIMBER TRCE
CONYERS GA
30094-4799
US

V. Phone/Fax

Practice location:
  • Phone: 678-587-9922
  • Fax: 678-587-9901
Mailing address:
  • Phone: 770-679-4413
  • Fax: 770-679-4414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number000653
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: