Individual
STEPHANIE H KONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
210 HANNAHS MILL RD, THOMASTON, GA 30286-2801
(706) 938-0990
Mailing address
210 HANNAHS MILL RD, THOMASTON, GA 30286-2801
(706) 938-0990
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
039388
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
956718471B
—
GA
05
—
956718471F
—
GA
Enumeration date
09/13/2005
Last updated
02/18/2014
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