Healthcare Provider Details

I. General information

NPI: 1467185629
Provider Name (Legal Business Name): GEORGE P STEVENS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 S MAIN ST
NEW AUGUSTA MS
39462-9756
US

IV. Provider business mailing address

PO BOX 1729
HATTIESBURG MS
39403-1729
US

V. Phone/Fax

Practice location:
  • Phone: 601-964-8391
  • Fax: 601-964-8393
Mailing address:
  • Phone: 601-255-2660
  • Fax: 601-255-2645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33413
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: