Healthcare Provider Details

I. General information

NPI: 1619513710
Provider Name (Legal Business Name): STEFKA LYRON AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2019
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 EXECUTIVE PARK DR NE
ATLANTA GA
30329-2206
US

IV. Provider business mailing address

2375 BETHANY CHURCH RD
SNELLVILLE GA
30039-3936
US

V. Phone/Fax

Practice location:
  • Phone: 404-770-5770
  • Fax:
Mailing address:
  • Phone: 770-845-0277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN289471
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN289471
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN289471
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: