Provider Demographics
NPI:1073757472
Name:STEPHENS, JAMES RONALD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RONALD
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1341 CANTON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6056
Mailing Address - Country:US
Mailing Address - Phone:770-422-0517
Mailing Address - Fax:678-638-7015
Practice Address - Street 1:1505 NORTHSIDE BLVD
Practice Address - Street 2:SUITE 1300
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7623
Practice Address - Country:US
Practice Address - Phone:404-686-2288
Practice Address - Fax:678-638-7015
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0162872083P0011X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAS6327414OtherDEA