Provider Demographics
NPI:1376648923
Name:MAHLE, STEPHANIE TAYLOR (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:TAYLOR
Last Name:MAHLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 SILVERTHORNE CIR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-7420
Mailing Address - Country:US
Mailing Address - Phone:770-942-3818
Mailing Address - Fax:678-567-5601
Practice Address - Street 1:328 SILVERTHORNE CIR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-7420
Practice Address - Country:US
Practice Address - Phone:770-942-3818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor