Healthcare Provider Details

I. General information

NPI: 1740395920
Provider Name (Legal Business Name): JOHN MARK STEVENSON SR. HAD-F
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 N MARIETTA PKWY SUITE E
MARIETTA GA
30060-8023
US

IV. Provider business mailing address

145 N MARIETTA PKWY SUITE E
MARIETTA GA
30060-8023
US

V. Phone/Fax

Practice location:
  • Phone: 770-590-8662
  • Fax:
Mailing address:
  • Phone: 770-590-8662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2124
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS000963
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: