Provider Demographics
NPI:1356689459
Name:BRIGHT, STEPHANIE D (PA-C)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:D
Last Name:BRIGHT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:677 CHURCH ST, BOX 111
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1101
Mailing Address - Country:US
Mailing Address - Phone:770-793-7750
Mailing Address - Fax:770-793-7755
Practice Address - Street 1:677 CHURCH ST, BOX 111
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1101
Practice Address - Country:US
Practice Address - Phone:770-793-7750
Practice Address - Fax:770-793-7755
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA006701363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant