Provider Demographics
NPI:1073112249
Name:COLLIER, STEPHANIE
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:COLLIER
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 1:346 STONE MILL WALK
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-5465
Mailing Address - Country:US
Mailing Address - Phone:678-953-3528
Mailing Address - Fax:678-688-3892
Practice Address - Street 1:625 CARVER RD
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-3937
Practice Address - Country:US
Practice Address - Phone:770-227-9222
Practice Address - Fax:678-688-3891
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006385363LF0000X
GARN124911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily