Fennell, Stephanie S

Fennell, Stephanie S is an individual health care provider with primary practice located at 509 Gordon Ave , Thomasville GA 31792-6645. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Fennell, Stephanie S can be contacted via phone (229) 226-7544.

Contact Information

Primary practice address
509 Gordon Ave Thomasville GA 31792-6645
Fax: (229) 226-0314
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 041552 Georgia

Profile Details

NPI number 1154398865
LBN Legal business name Fennell, Stephanie S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 1st, 2006
Last updated Jan 12th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154398865 NPPES
Georgia MEDICAID 000705691A
Georgia MEDICAID 000705691B

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