Provider Demographics
NPI:1720866122
Name:STAGNARO, JULIETTE ELISABETH
Entity Type:Individual
Prefix:
First Name:JULIETTE
Middle Name:ELISABETH
Last Name:STAGNARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 RHODES CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3665
Mailing Address - Country:US
Mailing Address - Phone:678-749-0790
Mailing Address - Fax:
Practice Address - Street 1:710 RHODES CREEK TRL
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-3665
Practice Address - Country:US
Practice Address - Phone:678-749-0790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant