Provider Demographics
NPI:1467496588
Name:WRENCHER, STEPHANIE NICOLE (PA-C)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:WRENCHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:2800 BUFORD DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-5107
Mailing Address - Country:US
Mailing Address - Phone:678-344-3744
Mailing Address - Fax:678-344-3757
Practice Address - Street 1:2800 BUFORD DRIVE SUITE 200
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519
Practice Address - Country:US
Practice Address - Phone:678-344-3744
Practice Address - Fax:678-344-3757
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2024-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA3273363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS74252Medicare UPIN