Provider Demographics
NPI:1003847898
Name:TAFT, STEPHANIE ANJA (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANJA
Last Name:TAFT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:A
Other - Last Name:WITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 749306
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:218 E BLACKSTOCK RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-2607
Practice Address - Country:US
Practice Address - Phone:864-576-8646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45310207P00000X
NC200400781207P00000X
OH35086087207P00000X
SC83711207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2546598Medicaid
NC1003847898Medicaid
MN357467000Medicaid
NC19CU4OtherBCBS NC
SCQ0078WMedicaid
WI34938000Medicaid
MN930002841Medicare UPIN
OH2546598Medicaid