Provider Demographics
NPI:1740751908
Name:STEPHENS, ALETHIA CUNNINGHAM
Entity Type:Individual
Prefix:
First Name:ALETHIA
Middle Name:CUNNINGHAM
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 1:514 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6836
Mailing Address - Country:US
Mailing Address - Phone:229-403-6223
Mailing Address - Fax:
Practice Address - Street 1:514 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6836
Practice Address - Country:US
Practice Address - Phone:229-403-6223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN162162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN162162OtherNEW GRADUATE NURSE PRACTITIONER