Provider Demographics
NPI:1679544001
Name:STEVENS, NORMAN BRAD (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:BRAD
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:330 HOSPITAL DR
Mailing Address - Street 2:BLDG C, STE 200
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3899
Mailing Address - Country:US
Mailing Address - Phone:478-745-1191
Mailing Address - Fax:478-752-3869
Practice Address - Street 1:330 HOSPITAL DR
Practice Address - Street 2:BLDG C, STE 200
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3899
Practice Address - Country:US
Practice Address - Phone:478-745-1191
Practice Address - Fax:478-752-3869
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00368904AMedicaid
GA00368904AMedicaid