Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 4889 | GA |
Y | 111NR0400X | Rehabilitation Chiropractor | 4889 | GA |
NPI | 1346396405 |
---|---|
Provider Name | Dr. Charles Nolan Stephens |
First Address | Milledgeville, GA 31061 |
Second Address | Milledgeville, GA 31061 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 13/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
35ZCCJX | (02) | GA |
U41924 | (02) |