Provider Demographics
NPI:1285263095
Name:STEPHENSON, JUDY ANNE (RDH)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:ANNE
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2637 ADAMS CLARKE RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30530-6021
Mailing Address - Country:US
Mailing Address - Phone:706-207-8124
Mailing Address - Fax:
Practice Address - Street 1:183 PARADISE BLVD STE 103B
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1169
Practice Address - Country:US
Practice Address - Phone:706-583-2665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH008756124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist