Provider Demographics
NPI:1104254457
Name:SNIPES, STEPHANIE EVELYN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:EVELYN
Last Name:SNIPES
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12465 STEVENS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-7445
Mailing Address - Country:US
Mailing Address - Phone:678-431-5675
Mailing Address - Fax:
Practice Address - Street 1:1155 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5425
Practice Address - Country:US
Practice Address - Phone:678-442-0205
Practice Address - Fax:678-442-0185
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3943363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant