Provider Demographics
NPI:1780658674
Name:LITTLE, STEPHEN L (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:L
Last Name:LITTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 LANIER PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501
Mailing Address - Country:US
Mailing Address - Phone:770-531-1515
Mailing Address - Fax:770-531-1930
Practice Address - Street 1:668 LANIER PARK DRIVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-531-1515
Practice Address - Fax:770-531-1930
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035933207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
16BDFGHMedicare ID - Type Unspecified
E34775Medicare UPIN