Healthcare Provider Details

I. General information

NPI: 1841360039
Provider Name (Legal Business Name): DAN BRYAN STEPHENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 VANN ST NE SUITE 300
MARIETTA GA
30060-7297
US

IV. Provider business mailing address

140 VANN ST NE SUITE 300
MARIETTA GA
30060-7297
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-9799
  • Fax: 770-422-2872
Mailing address:
  • Phone: 770-422-9799
  • Fax: 770-422-2872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number012372
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number012372
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: