Individual
STEPHANIE S FENNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
509 GORDON AVE, THOMASVILLE, GA 31792-6645
(229) 226-7544
(229) 226-0314
Mailing address
PO BOX 2258, THOMASVILLE, GA 31799-2258
(229) 226-7544
(229) 226-0314
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
041552
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000705691A
—
GA
05
—
000705691B
—
GA
Enumeration date
03/01/2006
Last updated
01/12/2011
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