Healthcare Provider Details

I. General information

NPI: 1700797891
Provider Name (Legal Business Name): STEPHANIE PUNKAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 CHURCH ST NE
MARIETTA GA
30060-1101
US

IV. Provider business mailing address

2992 FOREST CHASE TER NE
MARIETTA GA
30066-1461
US

V. Phone/Fax

Practice location:
  • Phone: 770-793-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number2357
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: