Provider Demographics
NPI:1043291214
Name:STEPHENSON, JOHN RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARD
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7217
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-7217
Mailing Address - Country:US
Mailing Address - Phone:706-322-2462
Mailing Address - Fax:706-322-2891
Practice Address - Street 1:2300 MANCHESTER EXPY
Practice Address - Street 2:STE 101A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6802
Practice Address - Country:US
Practice Address - Phone:706-322-2462
Practice Address - Fax:706-322-2891
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018255207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000112373Medicaid
AL009929035Medicaid
20NCCRCOtherMEDICARE PTAN
GA00112373HMedicaid
GA582646818STEOtherEVERGREEN
GACJ5373Medicare ID - Type UnspecifiedGROUP RAILROAD MEDICARE
GA000115909012OtherUNITED HEALTHCARE
GA1590337OtherCIGNA
AL060030244OtherBLUE CROSS
GA20BBFRWMedicare ID - Type Unspecified
GAD42080Medicare UPIN
GA007569OtherBLUE CROSS
AL529909670Medicaid
GA158727900OtherDEPARTMENT OF LABOR
AL009929035Medicaid