Provider Demographics
NPI:1437533312
Name:PETERSON, STEPHANIE (PA-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:FRANKLYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3379 PEACHTREE ROAD NE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326
Mailing Address - Country:US
Mailing Address - Phone:404-266-1212
Mailing Address - Fax:404-365-8814
Practice Address - Street 1:3379 PEACHTREE ROAD NE
Practice Address - Street 2:SUITE 800
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326
Practice Address - Country:US
Practice Address - Phone:404-266-1212
Practice Address - Fax:404-365-8814
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9108514363AM0700X
GA8204363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical