Individual
LUCRETIUS D STEPHENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDP
Contact information
Practice address
3301 13TH AVE, COLUMBUS, GA 31904-7822
(706) 992-6330
Mailing address
3301 13TH AVE, COLUMBUS, GA 31904-7822
(706) 992-6330
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
Primary
—
—
251J00000X
Nursing Care Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
903667039
GA
261QM0850X
Adult Mental Health Clinic/Center
—
—
343800000X
Secured Medical Transport (VAN)
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
903667039
—
GA
05
—
903776039
—
GA
Enumeration date
11/03/2020
Last updated
10/26/2022
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