Provider Demographics
NPI:1780912071
Name:POLSINELLI, STEPHANIE (PA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:POLSINELLI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 GLENRIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5579
Mailing Address - Country:US
Mailing Address - Phone:404-816-3000
Mailing Address - Fax:404-946-0404
Practice Address - Street 1:5730 GLENRIDGE DR STE 100
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-5579
Practice Address - Country:US
Practice Address - Phone:404-816-3000
Practice Address - Fax:404-946-0404
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5724363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
5724OtherSTATE LICENSE