Individual
DR. STEPHANIE LYNETTE POOLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
611 CAMPBELL HILL ST NW STE 103, MARIETTA, GA 30060-1386
(770) 499-8909
(770) 499-8911
Mailing address
611 CAMPBELL HILL ST. STE. 103, MARIETTA, GA 30060
(770) 499-8909
(770) 499-8911
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
047011
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000949044D
—
GA
01
—
047011
LICENSE
GA
01
—
412137622
TAX ID
GA
Enumeration date
11/29/2006
Last updated
01/31/2020
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