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General NPI Number Information
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NPI Number | 1366612491
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Entity Type | Organization
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Legal Business Name | SANDI J. STEPHENS INC.
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 431 W PONCE DE LEON AVE SUITE 7
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City | DECATUR
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State | GA
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Zip | 30030-2458
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Country | US
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Telephone | 404-964-1072
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Fax |
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Provider Business Mailing Address
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Address Line | 250 NORWOOD AVE NE
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City | ATLANTA
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State | GA
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Zip | 30317-1248
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Country | US
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Telephone | 404-964-1072
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANDI JACQUELYN STEPHENS
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Credential |
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Telephone | 404-964-1072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 004092
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License Number State | GA
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