Provider Demographics
NPI:1982016978
Name:STEPHENS, GEORGE (CRT)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 TIMBER TRCE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-4799
Mailing Address - Country:US
Mailing Address - Phone:770-679-4413
Mailing Address - Fax:770-679-4414
Practice Address - Street 1:6600 PEACHTREE DUNWOODY RD
Practice Address - Street 2:BLDG 400 STE 125
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-6773
Practice Address - Country:US
Practice Address - Phone:678-587-9922
Practice Address - Fax:678-587-9901
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000653227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified