Healthcare Provider Details

I. General information

NPI: 1578590311
Provider Name (Legal Business Name): LISA H. STEVENS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S THORNTON AVE
DALTON GA
30720-8285
US

IV. Provider business mailing address

2310 COLEY FARM RD
ROCKY FACE GA
30740-9734
US

V. Phone/Fax

Practice location:
  • Phone: 706-226-1146
  • Fax:
Mailing address:
  • Phone: 706-673-6151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number040248
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number040248
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: