Provider Demographics
NPI:1386667921
Name:STEVENS, JOY MANRY (NP)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:MANRY
Last Name:STEVENS
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:151 SOUTHHALL LN
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7176
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:771 OLD NORCROSS ROAD
Practice Address - Street 2:SUITE 260
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4981
Practice Address - Country:US
Practice Address - Phone:770-962-5040
Practice Address - Fax:770-962-5056
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-12-22
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Provider Licenses
StateLicense IDTaxonomies
GARN108425363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I500996Medicare PIN
GA202I502915Medicare PIN
GA42BBBRWMedicare ID - Type Unspecified