MEDICARE: STEPHANIE STANDRIDGE CNM

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	367A00000X	Advanced Practice Midwife	194197	GA

General Provider Information

NPI Number	:	1902285398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE STANDRIDGE CNM

Provider Business Mailing Address
First Line	:	3240 AVALON BLVD
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-6320
Country	:	US
Telephone Number	:	770-860-1133
Fax Number	:	770-860-1941

Provider Business Practice Location Address
First Line	:	3240 AVALON BLVD
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-6320
Country	:	US
Telephone Number	:	770-860-1133
Fax Number	:	770-860-1941

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

Provider Enumeration Date	:	05/19/2015
Last Update Date	:	01/14/2026

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