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General NPI Number Information
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NPI Number | 1306017728
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Entity Type | Organization
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Legal Business Name | STEPHEN A. BYRNE
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 09/23/2010
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Provider Practice Location Address
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Address Line | 224 RIVERSTONE DR
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City | CANTON
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State | GA
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Zip | 30114-5256
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Country | US
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Telephone | 770-479-4011
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Fax | 770-809-5011
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Provider Business Mailing Address
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Address Line | 224 RIVERSTONE DR
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City | CANTON
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State | GA
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Zip | 30114-5256
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Country | US
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Telephone | 770-479-4011
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Fax | 770-809-5011
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. STEPHEN A BYRNE
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Credential | D.P.M.
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Telephone | 770-479-4011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 000515
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License Number State | GA
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