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General NPI Number Information
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NPI Number | 1376135798
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Entity Type | Individual
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Provider Name | STEPHANIE LYNE CHADWICK FNP
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Gender | Female
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Dates
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Enumeration Date | 02/08/2021
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 3345 US HIGHWAY 84 STE 102
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City | BLACKSHEAR
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State | GA
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Zip | 31516-2160
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Country | US
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Telephone | 912-228-1358
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Fax |
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Provider Business Mailing Address
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Address Line | 2992 ODUM SCREVEN RD
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City | SCREVEN
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State | GA
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Zip | 31560-9537
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Country | US
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Telephone | 912-294-2859
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN169513
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License Number State | GA
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