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General NPI Number Information
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NPI Number | 1730458829
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Entity Type | Organization
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Legal Business Name | ACADEMIA OF ENDOSCOPIC SURGERY AND WOMENS HEALTH, LLC
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Dates
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Enumeration Date | 12/20/2011
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 755 MOUNT VERNON HWY SUITE 240
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City | ATLANTA
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State | GA
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Zip | 30328-4274
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Country | US
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Telephone | 404-549-3224
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Fax | 404-459-0995
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Provider Business Mailing Address
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Address Line | 755 MOUNT VERNON HWY SUITE 240
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City | ATLANTA
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State | GA
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Zip | 30328-4274
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Country | US
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Telephone | 404-549-3224
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Fax | 404-459-0995
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. ASSIA A STEPANIAN
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Credential | M.D.
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Telephone | 404-549-3224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 055978
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License Number State | GA
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