Healthcare Provider Details

I. General information

NPI: 1023996543
Provider Name (Legal Business Name): STEPHANIE NICOLE GREENE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 COLLIER RD NW STE 775
ATLANTA GA
30309-1608
US

IV. Provider business mailing address

1266 SILVERCREST CT
POWDER SPRINGS GA
30127-6084
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-7100
  • Fax:
Mailing address:
  • Phone: 470-658-8703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN250182
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: