Healthcare Provider Details

I. General information

NPI: 1376911529
Provider Name (Legal Business Name): LEIGH ANN STEPHENS WILSON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS LEIGH ANN STEPHENS

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 JORDAN RD STE 200
FRANKLIN TN
37067-4495
US

IV. Provider business mailing address

163 SEBASTIAN DR
EATONTON GA
31024-5750
US

V. Phone/Fax

Practice location:
  • Phone: 706-474-4235
  • Fax: 877-319-4345
Mailing address:
  • Phone: 706-474-4235
  • Fax: 877-319-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG0815143
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: