Healthcare Provider Details

I. General information

NPI: 1689171027
Provider Name (Legal Business Name): STEPHANIE POTEAU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 RIDENOUR BLVD NW STE 300
KENNESAW GA
30152-4402
US

IV. Provider business mailing address

22 IBM RD STE 210
POUGHKEEPSIE NY
12601-5457
US

V. Phone/Fax

Practice location:
  • Phone: 770-702-1806
  • Fax:
Mailing address:
  • Phone: 845-790-2612
  • Fax: 845-790-2675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number101183
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: