Healthcare Provider Details

I. General information

NPI: 1699875393
Provider Name (Legal Business Name): STEPHANIE MCNAMARA HINES ATC, OTC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 PEACHTREE RD NE SUITE 705
ATLANTA GA
30309-1476
US

IV. Provider business mailing address

3552 CHATTAHOOCHEE SUMMIT LN SE
ATLANTA GA
30339-3290
US

V. Phone/Fax

Practice location:
  • Phone: 404-425-1165
  • Fax: 404-425-1063
Mailing address:
  • Phone: 404-558-4485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number07-0802
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT001430
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: