Provider Demographics
NPI:1154347490
Name:CROLL, STEPHANIE D (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:D
Last Name:CROLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 15849
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2549
Mailing Address - Country:US
Mailing Address - Phone:912-303-3552
Mailing Address - Fax:912-303-3506
Practice Address - Street 1:1326 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3928
Practice Address - Country:US
Practice Address - Phone:912-527-5200
Practice Address - Fax:912-527-5223
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-08-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAGA026247207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000287724IMedicaid
GA000287724IMedicaid
D17536Medicare UPIN