Healthcare Provider Details

I. General information

NPI: 1467790915
Provider Name (Legal Business Name): TAMMY LYNN STEPHENS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6055 LAKESIDE COMMONS DR STE 320
MACON GA
31210-5791
US

IV. Provider business mailing address

6055 LAKESIDE COMMONS DR STE 320
MACON GA
31210-5791
US

V. Phone/Fax

Practice location:
  • Phone: 478-238-9344
  • Fax: 478-225-0566
Mailing address:
  • Phone: 478-238-9344
  • Fax: 478-225-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN101834
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: