Provider Demographics
NPI:1558773002
Name:STELLA MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:STELLA MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANAELE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:678-594-3881
Mailing Address - Street 1:2121 FAIRBURN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1007
Mailing Address - Country:US
Mailing Address - Phone:678-594-3881
Mailing Address - Fax:687-594-3871
Practice Address - Street 1:2121 FAIRBURN RD
Practice Address - Street 2:SUITE B
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1007
Practice Address - Country:US
Practice Address - Phone:678-594-3881
Practice Address - Fax:687-594-3871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN135346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty