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General NPI Number Information
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NPI Number | 1598064172
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Entity Type | Individual
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Provider Name | DESHAWN TRAMARAL STEVENSON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 03/22/2011
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 1436 DOGWOOD DR SE
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City | CONYERS
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State | GA
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Zip | 30013-5091
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Country | US
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Telephone | 770-860-8806
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Fax |
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Provider Business Mailing Address
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Address Line | 1740 CENTURY CIR NE APT 1353
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City | ATLANTA
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State | GA
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Zip | 30345-3049
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Country | US
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Telephone | 404-901-9605
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH025759
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License Number State | GA
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