Organization
STELLA MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLINE ANAELE (OWNER)
(770) 855-2308
Entity
Organization
Contact information
Practice address
2121 FAIRBURN RD STE B, DOUGLASVILLE, GA 30135-1029
(770) 855-2308
Mailing address
2121 FAIRBURN RD STE B, DOUGLASVILLE, GA 30135-1029
(770) 855-2308
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN135346
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
456441108E
—
GA
Enumeration date
04/14/2014
Last updated
04/14/2014
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