Provider Demographics
NPI:1760675466
Name:KISSINGER, STEPHEN NEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:NEIL
Last Name:KISSINGER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2060 RIVERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4026
Mailing Address - Country:US
Mailing Address - Phone:770-640-5069
Mailing Address - Fax:770-640-5069
Practice Address - Street 1:2060 RIVERSIDE RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4026
Practice Address - Country:US
Practice Address - Phone:770-640-5069
Practice Address - Fax:770-640-5069
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-26
Last Update Date:2007-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0304932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE99973Medicare UPIN