Provider Demographics
NPI:1033151063
Name:GARDNER, STEPHANIE STEIN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:STEIN
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:59 TIPTON DR
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-1603
Mailing Address - Country:US
Mailing Address - Phone:770-800-3455
Mailing Address - Fax:770-450-8024
Practice Address - Street 1:11315 JOHNS CREEK PKWY STE 140
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-2665
Practice Address - Country:US
Practice Address - Phone:770-800-3455
Practice Address - Fax:770-450-8024
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA32567207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA032567OtherMEDICAL LICENSE
GA003136732BMedicaid
GA003136732CMedicaid
GA003136732AMedicaid
GA003136732CMedicaid
GA202I078452Medicare PIN