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General NPI Number Information
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NPI Number | 1467779082
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Entity Type | Organization
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Legal Business Name | STEVENS HEALTH SERVICES PC
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Dates
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Enumeration Date | 04/21/2010
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 201 E 16TH AVE
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City | CORDELE
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State | GA
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Zip | 31015-1623
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Country | US
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Telephone | 229-273-8501
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Fax | 877-325-1992
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Provider Business Mailing Address
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Address Line | 201 E 16TH AVE
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City | CORDELE
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State | GA
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Zip | 31015-1623
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Country | US
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Telephone | 229-273-8501
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Fax | 877-325-1992
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Authorized Official
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Title or Position | OWNER
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Name | MR. RICHARD L STEVENS
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Credential | M.D.
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Telephone | 229-273-8501
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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 |
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License Number State |
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