Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 030222 | GA |
NPI | 1003919457 |
---|---|
Provider Name | Richard N Stephens |
First Address | Atlanta, GA 30305-1736 |
Second Address | Atlanta, GA 30328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E90210 | (02) |