Healthcare Provider Details

I. General information

NPI: 1407822745
Provider Name (Legal Business Name): STEPHEN SALVATORE SALMIERI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 OLD NORCROSS RD
LAWRENCEVILLE GA
30046-4317
US

IV. Provider business mailing address

759 OLD NORCROSS RD SUITE 910
LAWRENCEVILLE GA
30046-4317
US

V. Phone/Fax

Practice location:
  • Phone: 678-442-3121
  • Fax: 678-376-4045
Mailing address:
  • Phone: 404-303-3750
  • Fax: 404-252-4755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number049151
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: