Provider Demographics
NPI:1538137096
Name:STEPHENS, PAULA K (CRNA)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:K
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 AURIE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-2913
Mailing Address - Country:US
Mailing Address - Phone:404-402-0227
Mailing Address - Fax:404-241-2303
Practice Address - Street 1:2380 AURIE DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-2913
Practice Address - Country:US
Practice Address - Phone:404-244-9515
Practice Address - Fax:404-241-2303
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN077653367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP12683Medicare UPIN
GA43BBBWDMedicare PIN