=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669309977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEPHANIE RENEE'S SALON AND MED SPA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2026
-----------------------------------------------------
Last Update Date | 05/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 N HUTCHINSON AVE
-----------------------------------------------------
City | ADEL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31620-2344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-507-9102
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 N HUTCHINSON AVE
-----------------------------------------------------
City | ADEL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31620-2344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-507-9102
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | STEPHANIE RENEE MILLER
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 229-507-9102
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QX0100X
-----------------------------------------------------
Taxonomy Name | Occupational Medicine Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------