Provider Demographics
NPI:1093751117
Name:MESSNER, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MESSNER
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 1:975 JOHNSON FY RD NE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1619
Mailing Address - Country:US
Mailing Address - Phone:404-785-3820
Mailing Address - Fax:404-785-3850
Practice Address - Street 1:975 JOHNSON FY RD NE
Practice Address - Street 2:SUITE 350
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1619
Practice Address - Country:US
Practice Address - Phone:404-785-3820
Practice Address - Fax:404-785-3850
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59282208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I12068Medicare UPIN
FL46679Medicare ID - Type Unspecified