Healthcare Provider Details

I. General information

NPI: 1891957627
Provider Name (Legal Business Name): JEFFREY JOSEPH STEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 WHITCHER ST NE STE 2100
MARIETTA GA
30060-1179
US

IV. Provider business mailing address

61 WHITCHER ST NE STE 2100
MARIETTA GA
30060-1179
US

V. Phone/Fax

Practice location:
  • Phone: 770-423-0595
  • Fax: 678-391-5055
Mailing address:
  • Phone: 770-423-0595
  • Fax: 678-391-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberR2752
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number94616
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: