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General NPI Number Information
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NPI Number | 1396299061
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Entity Type | Individual
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Provider Name | STEPHANIE MICHELLE ZIMMERMAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/10/2016
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 575 FURYS FERRY RD
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City | MARTINEZ
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State | GA
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Zip | 30907-9059
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Country | US
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Telephone | 706-691-7079
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Fax | 706-364-0416
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Provider Business Mailing Address
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Address Line | 575 FURYS FERRY RD
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City | MARTINEZ
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State | GA
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Zip | 30907-9059
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Country | US
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Telephone | 706-922-6179
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Fax | 706-922-6335
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 8102
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License Number State | GA
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