Provider Demographics
NPI:1194043844
Name:TARRACCIANO, STEPHANIE MARY (DO)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MARY
Last Name:TARRACCIANO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MARY
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3869 HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-3918
Mailing Address - Country:US
Mailing Address - Phone:770-466-3622
Mailing Address - Fax:770-466-3630
Practice Address - Street 1:3869 HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-3918
Practice Address - Country:US
Practice Address - Phone:770-466-3622
Practice Address - Fax:770-466-3630
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA072138207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology