Provider Demographics
NPI:1881293736
Name:STEVENSON, ALICIA LENETTE (NP-C)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:LENETTE
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:NP-C
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 492677
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30049-0045
Mailing Address - Country:US
Mailing Address - Phone:404-733-6089
Mailing Address - Fax:
Practice Address - Street 1:4835 SUGARLOAF PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-6916
Practice Address - Country:US
Practice Address - Phone:470-375-5940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN256527363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner