Provider Demographics
NPI:1033890405
Name:STEPHENSON, SUMMER GRACE
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:GRACE
Last Name:STEPHENSON
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 1:41 MOUNT OLIVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-2100
Mailing Address - Country:US
Mailing Address - Phone:229-326-2610
Mailing Address - Fax:
Practice Address - Street 1:41 MOUNT OLIVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-2100
Practice Address - Country:US
Practice Address - Phone:229-326-2610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical