Provider Demographics
NPI:1841964384
Name:STEGEMAN, CECILIE MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:CECILIE
Middle Name:MARIE
Last Name:STEGEMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1577 TIMBERRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-5280
Mailing Address - Country:US
Mailing Address - Phone:801-458-8321
Mailing Address - Fax:
Practice Address - Street 1:371 E PACES FERRY RD NE STE 850
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-3293
Practice Address - Country:US
Practice Address - Phone:404-963-6665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10483363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant