Provider Demographics
NPI:1639290513
Name:ATKINSON, STEFAN SHANE (CFO, ROA)
Entity Type:Individual
Prefix:
First Name:STEFAN
Middle Name:SHANE
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:CFO, ROA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 CRUTCHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2725
Mailing Address - Country:US
Mailing Address - Phone:919-471-4994
Mailing Address - Fax:919-471-4995
Practice Address - Street 1:314 CRUTCHFIELD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2725
Practice Address - Country:US
Practice Address - Phone:919-471-4994
Practice Address - Fax:919-471-4995
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4215300001Medicare NSC
NC1639290513Medicare PIN