Healthcare Provider Details

I. General information

NPI: 1487583555
Provider Name (Legal Business Name): DESTINY STEPHENS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E FREEWAY DR SE
CONYERS GA
30094-5965
US

IV. Provider business mailing address

3815 CAMERON TRL SE
CONYERS GA
30013-2286
US

V. Phone/Fax

Practice location:
  • Phone: 770-922-8222
  • Fax:
Mailing address:
  • Phone: 910-229-9566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF02250432
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: