Provider Demographics
NPI:1013177849
Name:STEPHANSSON, REANNE PARRENAS (MDFAAP)
Entity Type:Individual
Prefix:
First Name:REANNE
Middle Name:PARRENAS
Last Name:STEPHANSSON
Suffix:
Gender:F
Credentials:MDFAAP
Other - Prefix:
Other - First Name:REANNE
Other - Middle Name:
Other - Last Name:PARRENAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11975 MORRIS ROAD
Mailing Address - Street 2:STE 210
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:770-664-0088
Mailing Address - Fax:770-664-8228
Practice Address - Street 1:11975 MORRIS ROAD
Practice Address - Street 2:STE 210
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:770-664-0088
Practice Address - Fax:770-664-8228
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066084208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics