Provider Demographics
NPI:1295141307
Name:STEPHENS, LARA (APRN, WHNP-BC)
Entity type:Individual
Prefix:MS
First Name:LARA
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:APRN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 HOSPITAL SOUTH DR STE 301
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 HOSPITAL SOUTH DR STE 301
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8116
Practice Address - Country:US
Practice Address - Phone:770-819-9211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN177122163WW0101X, 363LP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP1700XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPerinatal
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory