Provider Demographics
NPI:1275618365
Name:WINN, STEPHANIE SMITH (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SMITH
Last Name:WINN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8925 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2116
Mailing Address - Country:US
Mailing Address - Phone:404-778-2524
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON RD NE STE 6100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-2524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0381342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00734071GMedicaid
GA00734071GMedicaid
G54635Medicare UPIN