MEDICARE: DR. STEPHANIE NMI CALHOUN-JAMISON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	011651	GA
2	1223E0200X	Endodontics	011651	GA

General Provider Information

NPI Number	:	1043280183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE NMI CALHOUN-JAMISON DDS

Provider Business Mailing Address
First Line	:	577 STERNBERG AVE
Second Line	:
City	:	FORT EUSTIS
State	:	VA
Zip	:	23604-1526
Country	:	US
Telephone Number	:	757-314-7980
Fax Number	:

Provider Business Practice Location Address
First Line	:	577 STERNBERG AVE
Second Line	:
City	:	FORT EUSTIS
State	:	VA
Zip	:	23604-1526
Country	:	US
Telephone Number	:	757-314-7980
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	03/08/2023

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