Provider Demographics
NPI:1750350237
Name:FISHER, STEPHEN RONALD (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RONALD
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:3400 OLD MILTON PKWY STE 190
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:770-663-1100
Practice Address - Fax:770-663-1101
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISF068421207X00000X
GA062037207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003107001DMedicaid
MI4352496Medicaid
GA52305563OtherBCBS
GA7337297OtherAETNA
GA003107001BMedicaid
GA8306576OtherCIGNA
GA003107001AMedicaid
GA2151393OtherUNITEH HEALTHCARE
GA003107001CMedicaid
GA003107001EMedicaid
GA7337297OtherAETNA
H40957Medicare UPIN
GA003107001BMedicaid