Healthcare Provider Details

I. General information

NPI: 1073757472
Provider Name (Legal Business Name): JAMES RONALD STEPHENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 NORTHSIDE BLVD SUITE 1300
CUMMING GA
30041-7623
US

IV. Provider business mailing address

1341 CANTON RD SUITE A
MARIETTA GA
30066-6056
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-2288
  • Fax: 678-638-7015
Mailing address:
  • Phone: 770-422-0517
  • Fax: 678-638-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number016287
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number016287
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: