Healthcare Provider Details

I. General information

NPI: 1437743101
Provider Name (Legal Business Name): STEPHANIE DUFFY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 CONTINENTAL DR
MCDONOUGH GA
30252-1655
US

IV. Provider business mailing address

616 CONTINENTAL DR
MCDONOUGH GA
30252-1655
US

V. Phone/Fax

Practice location:
  • Phone: 470-230-1270
  • Fax:
Mailing address:
  • Phone: 470-230-1270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: