Provider Demographics
NPI:1902807910
Name:STEPNICKA, JILL KATHLEEN (DPM)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:KATHLEEN
Last Name:STEPNICKA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4385 JOHNS CREEK PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6093
Mailing Address - Country:US
Mailing Address - Phone:770-418-0456
Mailing Address - Fax:770-418-1603
Practice Address - Street 1:4385 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6093
Practice Address - Country:US
Practice Address - Phone:770-418-0456
Practice Address - Fax:770-418-1603
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000863213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA260427OtherCOVENTRY
8694962OtherCIGNA
GA000870471DMedicaid
52825629OtherBCBS
7882185OtherAETNA
GA48SCCSKMedicare ID - Type Unspecified
GAU80353Medicare UPIN