Provider Demographics
NPI:1548658677
Name:STEPHENS, ANDREA LASHAWN (AGNP-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LASHAWN
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3938 ROBINDALE DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-7266
Mailing Address - Country:US
Mailing Address - Phone:614-314-8977
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON RD NE STE C2004
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1625
Practice Address - Country:US
Practice Address - Phone:706-295-5331
Practice Address - Fax:706-238-8011
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN238076363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner