Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 004092 | GA |
NPI | 1639349764 |
---|---|
Provider Name | Sandi Jacquelyn Stephens |
First Address | Ellijay, GA 30540-2353 |
Second Address | Decatur, GA 30030-2458 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2008 |
Last Update Date | 02/01/2013 |