Provider Demographics
NPI:1508070897
Name:SMALL, STEPHEN T (NP)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:T
Last Name:SMALL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-6820
Mailing Address - Country:US
Mailing Address - Phone:706-282-4200
Mailing Address - Fax:
Practice Address - Street 1:163 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-6820
Practice Address - Country:US
Practice Address - Phone:706-282-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN114168363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P70935Medicare UPIN