Provider Demographics
NPI:1275575540
Name:RESNICK, STEPHANIE H (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:H
Last Name:RESNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 W PACES FERRY RD NW STE 652
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2306
Mailing Address - Country:US
Mailing Address - Phone:678-802-9088
Mailing Address - Fax:
Practice Address - Street 1:993 JOHNSON FERRY RD STE D100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-303-4625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234678174400000X
GA061511207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No174400000XOther Service ProvidersSpecialist
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA290224729AMedicaid
GA290224729BMedicaid
GA511I050306Medicare PIN
GA290224729GMedicaid
GA290224729CMedicaid
GA290224729EMedicaid
GA290224729FMedicaid
GA290224729DMedicaid