Provider Demographics
NPI:1417115452
Name:PREAS, STEPHEN G (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:G
Last Name:PREAS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2430 TUCKER DR
Mailing Address - Street 2:BLDG A
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-4390
Mailing Address - Country:US
Mailing Address - Phone:770-554-8812
Mailing Address - Fax:770-554-9810
Practice Address - Street 1:2430 TUCKER DR
Practice Address - Street 2:BLDG A
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-4390
Practice Address - Country:US
Practice Address - Phone:770-554-8812
Practice Address - Fax:770-554-9810
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2011-10-20
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Provider Licenses
StateLicense IDTaxonomies
GA0197522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD40890Medicare UPIN