Provider Demographics
NPI:1033904586
Name:ETHERIDGE STEPHENS, GEORGIA (MA, CCLS)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:ETHERIDGE STEPHENS
Suffix:
Gender:
Credentials:MA, CCLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 S SIERRA BONITA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2551
Mailing Address - Country:US
Mailing Address - Phone:925-980-9793
Mailing Address - Fax:
Practice Address - Street 1:1159 S SIERRA BONITA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-2551
Practice Address - Country:US
Practice Address - Phone:925-980-9793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula