Healthcare Provider Details

I. General information

NPI: 1093821019
Provider Name (Legal Business Name): STEFANIE LEE SHAVER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KORITZ CLINIC 201 INDEPENDENCE DRIVE
COLUMBUS MS
39710-7139
US

IV. Provider business mailing address

201 INDEPENDENCE DRIVE KORITZ CLINIC
COLUMBUS MS
39710-7594
US

V. Phone/Fax

Practice location:
  • Phone: 662-434-2292
  • Fax:
Mailing address:
  • Phone: 404-432-2724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number056647
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number056647
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number56647
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number56647
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: