Individual
MICHELLE BIANCA STEVENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 N 1ST ST, JESUP, GA 31545-0046
(912) 530-8528
(912) 530-8091
Mailing address
211 O.F. LANIER RD, PEMBROKE, GA 31321
(912) 656-6943
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
002219
GA
Other
Enumeration date
10/16/2023
Last updated
10/16/2023
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