Provider Demographics
NPI:1487678751
Name:STEPHENSON, EARL JR (MD, DDS)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:
Last Name:STEPHENSON
Suffix:JR
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 WISTERIA DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-4606
Mailing Address - Country:US
Mailing Address - Phone:770-466-4700
Mailing Address - Fax:770-466-4750
Practice Address - Street 1:2220 WISTERIA DR
Practice Address - Street 2:SUITE 209
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-4606
Practice Address - Country:US
Practice Address - Phone:770-466-4700
Practice Address - Fax:770-466-4750
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA045975208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery