Provider Demographics
NPI:1023153772
Name:STEPHENSON, GEORGE (DC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-7931
Mailing Address - Country:US
Mailing Address - Phone:706-321-8444
Mailing Address - Fax:
Practice Address - Street 1:1237 PEACOCK AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2424
Practice Address - Country:US
Practice Address - Phone:706-321-8444
Practice Address - Fax:706-321-9050
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR001294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA58-1423865OtherEIN