Provider Demographics
NPI:1689311177
Name:STEPHENS, REBECCA ANNA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNA
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 PEBBLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3516
Mailing Address - Country:US
Mailing Address - Phone:470-350-4522
Mailing Address - Fax:
Practice Address - Street 1:2955 PEBBLEBROOK DR
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3516
Practice Address - Country:US
Practice Address - Phone:470-350-4522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program