Individual
JACK STEPHENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 EAST HOSPITAL ROAD, FORT GORDON, GA 30905
(706) 787-5811
Mailing address
785 MICHELLE CT, GROVETOWN, GA 30813-4867
(256) 749-0550
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1-168935
AL
Other
Enumeration date
05/20/2021
Last updated
05/20/2021
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