Healthcare Provider Details

I. General information

NPI: 1144331042
Provider Name (Legal Business Name): STEPHEN P AUDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N JEFF DAVIS DR
FAYETTEVILLE GA
30214-1627
US

IV. Provider business mailing address

325 N JEFF DAVIS DR
FAYETTEVILLE GA
30214-1627
US

V. Phone/Fax

Practice location:
  • Phone: 770-461-1337
  • Fax: 770-461-0922
Mailing address:
  • Phone: 770-461-1337
  • Fax: 770-461-0922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number020653
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: