Provider Demographics
NPI:1740547397
Name:STEVENSON-PIRKLE, RADONNA RAE (PA-C)
Entity type:Individual
Prefix:
First Name:RADONNA
Middle Name:RAE
Last Name:STEVENSON-PIRKLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RADONNA
Other - Middle Name:RAE
Other - Last Name:STEVENSON-CREASY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5353 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 N RIVER ST.
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-1659
Practice Address - Country:US
Practice Address - Phone:912-739-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003816363AS0400X
GA3816363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant