Provider Demographics
NPI:1366612491
Name:SANDI J. STEPHENS INC.
Entity type:Organization
Organization Name:SANDI J. STEPHENS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:JACQUELYN
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-964-1072
Mailing Address - Street 1:250 NORWOOD AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-1248
Mailing Address - Country:US
Mailing Address - Phone:404-964-1072
Mailing Address - Fax:
Practice Address - Street 1:431 W PONCE DE LEON AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2458
Practice Address - Country:US
Practice Address - Phone:404-964-1072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004092261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center