Healthcare Provider Details

I. General information

NPI: 1295141307
Provider Name (Legal Business Name): LARA STEPHENS APRN, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 HOSPITAL SOUTH DR STE 301
AUSTELL GA
30106-8116
US

IV. Provider business mailing address

1700 HOSPITAL SOUTH DR STE 301
AUSTELL GA
30106-8116
US

V. Phone/Fax

Practice location:
  • Phone: 770-819-9211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN177122
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP1700X
TaxonomyPerinatal Nurse Practitioner
License NumberRN177122
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: