Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 057499 | GA |
NPI | 1003858861 |
---|---|
Provider Name | Richard Ervin Stephens JR. |
First Address | Columbus, GA 31908-9027 |
Second Address | Columbus, GA 31904-6808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 07/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
202I169638 | MEDICARE PTAN (01) | GA |
531800006C | (05) | GA |
I52980 | (02) | GA |