Individual
NICHOLAS CARROLL DESTEFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 E HOSPITAL RD, FORT GORDON, GA 30905
(706) 383-5299
Mailing address
300 E HOSPITAL RD, FORT GORDON, GA 30905
(706) 383-5299
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
C1-0028577
DE
208D00000X
General Practice Physician
Primary
30177
NE
Other
Enumeration date
05/02/2016
Last updated
12/10/2025
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