Healthcare Provider Details

I. General information

NPI: 1548781081
Provider Name (Legal Business Name): CLIFFORD ALLEN STEPHENS DNP, RN, AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 07/21/2022
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 TURNER MCCALL BLVD SW
ROME GA
30165-5621
US

IV. Provider business mailing address

304 TURNER MCCALL BLVD SW
ROME GA
30165-5621
US

V. Phone/Fax

Practice location:
  • Phone: 706-266-6548
  • Fax: 706-292-7757
Mailing address:
  • Phone: 706-266-6548
  • Fax: 706-292-7757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN117538
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN117538
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: