Provider Demographics
NPI:1548869506
Name:GARBA, STEPHANIE REGINE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:REGINE
Last Name:GARBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:REGINE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:401 S MAIN ST STE C7
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-7960
Mailing Address - Country:US
Mailing Address - Phone:678-319-9901
Mailing Address - Fax:678-319-9902
Practice Address - Street 1:401 S MAIN ST STE C7
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7960
Practice Address - Country:US
Practice Address - Phone:678-319-9901
Practice Address - Fax:678-319-9902
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA217090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily