Provider Demographics
NPI:1922301118
Name:REDMOND, STEVIE MICHELLE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:STEVIE
Middle Name:MICHELLE
Last Name:REDMOND
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1350 WALTON WAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2612
Mailing Address - Country:US
Mailing Address - Phone:707-774-7022
Mailing Address - Fax:706-774-7023
Practice Address - Street 1:1350 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2612
Practice Address - Country:US
Practice Address - Phone:707-774-7022
Practice Address - Fax:706-774-7023
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA006016363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant