Provider Demographics
NPI:1134467301
Name:STEMBRIDGE, FREDICIA LASANDRA (NP-C)
Entity Type:Individual
Prefix:
First Name:FREDICIA
Middle Name:LASANDRA
Last Name:STEMBRIDGE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:FREDICIA
Other - Middle Name:LASANDRA
Other - Last Name:WALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 COLLIER RD NW STE 400
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1711
Mailing Address - Country:US
Mailing Address - Phone:404-605-4848
Mailing Address - Fax:
Practice Address - Street 1:275 COLLIER RD NW STE 400
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1711
Practice Address - Country:US
Practice Address - Phone:404-605-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN207096363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health