Provider Demographics
NPI:1750637088
Name:C. STEPHEN LITTLE, D.O., LLC
Entity Type:Organization
Organization Name:C. STEPHEN LITTLE, D.O., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:478-929-0294
Mailing Address - Street 1:2278 MOODY RD
Mailing Address - Street 2:BUILDING D
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-3247
Mailing Address - Country:US
Mailing Address - Phone:478-929-0294
Mailing Address - Fax:478-923-9770
Practice Address - Street 1:2278 MOODY RD
Practice Address - Street 2:BUILDING D
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-3247
Practice Address - Country:US
Practice Address - Phone:478-929-0294
Practice Address - Fax:478-923-9770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0356842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00612356AMedicaid
GA00612356AMedicaid