Provider Demographics
NPI:1326127853
Name:DORAN, STEPHEN D (DPT)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
Last Name:DORAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 ARCHMONT CIR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4557
Mailing Address - Country:US
Mailing Address - Phone:678-546-4720
Mailing Address - Fax:678-669-1667
Practice Address - Street 1:2386 CLOWER ST
Practice Address - Street 2:BUILD. E, SUITE 102
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6134
Practice Address - Country:US
Practice Address - Phone:770-985-9050
Practice Address - Fax:770-985-9223
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007230225100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00927297AMedicaid