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General NPI Number Information
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NPI Number | 1164684379
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Entity Type | Individual
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Provider Name | STEPHANIE MARIE POUCH M.D., M.S.
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Gender | Female
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Dates
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Enumeration Date | 06/29/2008
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 101 WOODRUFF CIRCLE WOODRUFF MEMORIAL RESEARCH BUILDING, SUITE 2101
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City | ATLANTA
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State | GA
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Zip | 30322
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Country | US
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Telephone | 404-712-7988
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Fax | 404-712-2278
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Provider Business Mailing Address
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Address Line | 101 WOODRUFF CIRCLE WOODRUFF MEMORIAL RESEARCH BUILDING SUITE 201
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City | ATLANTA
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State | GA
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Zip | 30322
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Country | US
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Telephone | 404-712-7988
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Fax | 404-712-2278
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C6454
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 35123764
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 077760
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License Number State | GA
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