Provider Demographics
NPI:1871747071
Name:NELSON, STEPHANIE L
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 SOUTH WASHINGTON ST
Mailing Address - Street 2:HEARST PLAZA, SUITE C
Mailing Address - City:LINCOLNTON
Mailing Address - State:GA
Mailing Address - Zip Code:30817
Mailing Address - Country:US
Mailing Address - Phone:706-816-8414
Mailing Address - Fax:
Practice Address - Street 1:1470 LEWIS RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:GA
Practice Address - Zip Code:30678-1103
Practice Address - Country:US
Practice Address - Phone:706-816-8414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA263691626OtherEIN NUMBER