Healthcare Provider Details

I. General information

NPI: 1548529290
Provider Name (Legal Business Name): STEPHANIE GREATHOUSE CAUSEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE GREATHOUSE CAVINESS PA

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CAIRO RD
THOMASVILLE GA
31792-4255
US

IV. Provider business mailing address

100 MIMOSA DRIVE 2ND FLOOR
THOMASVILLE GA
31792
US

V. Phone/Fax

Practice location:
  • Phone: 229-227-5102
  • Fax: 229-227-5187
Mailing address:
  • Phone: 229-551-0083
  • Fax: 229-227-9642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number006430
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: