Individual
MR. JONATHAN STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
121 EVERETT RD STE 100, ALBANY, NY 12205-1447
(518) 489-2663
(518) 689-6106
Mailing address
190 PINE CIR, BRUNSWICK, GA 31520-1638
(912) 270-5676
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
025354
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
025354
NYS LICENSE
NY
Enumeration date
07/16/2020
Last updated
05/12/2022
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