Provider Demographics
NPI:1922505213
Name:STEPHENS, DARRELL CLAUDE (CSFA)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:CLAUDE
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 PLANTATION RD SW
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-3045
Mailing Address - Country:US
Mailing Address - Phone:678-758-8164
Mailing Address - Fax:
Practice Address - Street 1:214 PLANTATION RD SW
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-3045
Practice Address - Country:US
Practice Address - Phone:678-758-8164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA180075363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical