Provider Demographics
NPI:1831179936
Name:STEPHENS, DIANA M (RN, MSN, GNP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:M
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:RN, MSN, GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 PEACHTREE DUNWOODY RD. NE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1713
Mailing Address - Country:US
Mailing Address - Phone:404-497-1830
Mailing Address - Fax:404-497-1828
Practice Address - Street 1:5505 PEACHTREE DUNWOODY RD. NE
Practice Address - Street 2:SUITE 230
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1713
Practice Address - Country:US
Practice Address - Phone:404-497-1830
Practice Address - Fax:404-497-1828
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN070926363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBGQTMedicare ID - Type Unspecified
P84845Medicare UPIN