Healthcare Provider Details

I. General information

NPI: 1245522473
Provider Name (Legal Business Name): LANCE STEPHENS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LANCE STEPHENS PA

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 05/13/2024
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321A INTERSTATE PKWY
AUGUSTA GA
30909-5626
US

IV. Provider business mailing address

1321A INTERSTATE PKWY
AUGUSTA GA
30909-5626
US

V. Phone/Fax

Practice location:
  • Phone: 706-738-7246
  • Fax: 706-738-7248
Mailing address:
  • Phone: 910-574-0573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10373
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number10373
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: