Provider Demographics
NPI:1306887047
Name:HASSEL MCNEIL, STEPHANIE L (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:HASSEL MCNEIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:HASSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 ACADEMY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-3008
Mailing Address - Country:US
Mailing Address - Phone:470-389-4970
Mailing Address - Fax:470-401-1089
Practice Address - Street 1:115 ACADEMY ST STE 101
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-3008
Practice Address - Country:US
Practice Address - Phone:470-389-4970
Practice Address - Fax:470-401-1089
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048642208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics