Provider Demographics
NPI:1851170138
Name:STONE, EGRETA (NP)
Entity Type:Individual
Prefix:
First Name:EGRETA
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:EGRETA
Other - Middle Name:
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:7870 BLEUSPARROW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-6541
Mailing Address - Country:US
Mailing Address - Phone:470-905-5162
Mailing Address - Fax:
Practice Address - Street 1:1465 WESTWOOD AVE SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-2346
Practice Address - Country:US
Practice Address - Phone:470-905-5162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN272145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily