Provider Demographics
NPI:1376911529
Name:STEPHENS WILSON, LEIGH ANN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:ANN
Last Name:STEPHENS WILSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:LEIGH
Other - Middle Name:ANN
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:163 SEBASTIAN DR
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-5750
Mailing Address - Country:US
Mailing Address - Phone:706-474-4235
Mailing Address - Fax:877-319-4345
Practice Address - Street 1:201 JORDAN RD STE 200
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-4495
Practice Address - Country:US
Practice Address - Phone:706-474-4235
Practice Address - Fax:877-319-4345
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAG0815143363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003168421AMedicaid