Individual
JOHNNA HICKS STEVENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
BEAUFORT MEMORIAL BLUFFTON PRIMARY CARE, 11 ARLEY WAY, STE 201, BLUFFTON, SC 29910-4883
(843) 706-8690
(844) 295-9802
Mailing address
955 RIBAUT RD, BMAC CREDENTIALING, BEAUFORT, SC 29902-5441
(843) 522-7843
(843) 522-5678
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
78307
GA
207R00000X
Internal Medicine Physician
Primary
81571
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81571
STATE LICENSE BOARD
SC
05
—
815719
—
SC
Enumeration date
09/05/2012
Last updated
11/13/2019
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