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General NPI Number Information
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NPI Number | 1093821019
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Entity Type | Individual
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Provider Name | STEFANIE LEE SHAVER M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | KORITZ CLINIC 201 INDEPENDENCE DRIVE
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City | COLUMBUS
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State | MS
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Zip | 39710-7139
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Country | US
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Telephone | 662-434-2292
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Fax |
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Provider Business Mailing Address
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Address Line | 201 INDEPENDENCE DRIVE KORITZ CLINIC
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City | COLUMBUS
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State | MS
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Zip | 39710-7594
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Country | US
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Telephone | 404-432-2724
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 056647
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 56647
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 056647
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 2083A0100X
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Taxonomy Name | Aerospace Medicine Physician
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License Number | 56647
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License Number State | GA
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