Provider Demographics
NPI:1467185629
Name:STEVENS, GEORGE P (DO, MS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:P
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:DR
Other - First Name:GEORGE
Other - Middle Name:P
Other - Last Name:STAVRIANOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO, MS
Mailing Address - Street 1:1462 S COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-7232
Mailing Address - Country:US
Mailing Address - Phone:601-402-6402
Mailing Address - Fax:
Practice Address - Street 1:1400 E UNION ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-3246
Practice Address - Country:US
Practice Address - Phone:601-402-6402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-4563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine