Healthcare Provider Details

I. General information

NPI: 1427967033
Provider Name (Legal Business Name): STEPHEN DUVALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 CHICAMAUGA CT
LOGANVILLE GA
30052-8004
US

IV. Provider business mailing address

404 CHICAMAUGA CT
LOGANVILLE GA
30052-8004
US

V. Phone/Fax

Practice location:
  • Phone: 404-710-5366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: