Provider Demographics
NPI:1326265968
Name:ALMEDOM, STIFANOS T (PA)
Entity Type:Individual
Prefix:MR
First Name:STIFANOS
Middle Name:T
Last Name:ALMEDOM
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2130 THORNDALE DR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4740
Mailing Address - Country:US
Mailing Address - Phone:770-978-0149
Mailing Address - Fax:404-616-2515
Practice Address - Street 1:2130 THORNDALE DR SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-4740
Practice Address - Country:US
Practice Address - Phone:770-978-0149
Practice Address - Fax:404-616-2515
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA003619363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant