Provider Demographics
NPI:1689881732
Name:MEYERS, STEPHEN N NEIL (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN N
Middle Name:NEIL
Last Name:MEYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:S
Other - Middle Name:NEIL
Other - Last Name:MEYERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3131
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31604-3131
Mailing Address - Country:US
Mailing Address - Phone:229-333-0504
Mailing Address - Fax:229-333-0150
Practice Address - Street 1:2704 NORTH OAK STREET
Practice Address - Street 2:BUILDING M
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1791
Practice Address - Country:US
Practice Address - Phone:229-333-0504
Practice Address - Fax:229-333-0150
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0228412083X0100X, 208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0101932OtherUNITED HEALTHCARE
GA00253096HMedicaid
GA202I086627OtherMEDICARE PTAN
GA257879OtherBLUE CROSS & BLUE SHIELD
A002OtherTRICARE
08BDCJVMedicare PIN
D46125Medicare UPIN