Healthcare Provider Details

I. General information

NPI: 1508741257
Provider Name (Legal Business Name): SAPPHIRE'S INFUSION AND WOUND CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 MILSTEAD RD NE STE 101
CONYERS GA
30012-3824
US

IV. Provider business mailing address

1315 MILSTEAD RD NE STE 101
CONYERS GA
30012-3824
US

V. Phone/Fax

Practice location:
  • Phone: 470-217-8445
  • Fax: 470-300-7778
Mailing address:
  • Phone: 470-217-8445
  • Fax: 470-300-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELLA STEPHENSON
Title or Position: ADMINISTRATOR/DON
Credential: RN
Phone: 470-217-8445