Provider Demographics
NPI:1326889759
Name:BONE, STEPHANIE M (LMT,BWS,LDS,CR)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:BONE
Suffix:
Gender:F
Credentials:LMT,BWS,LDS,CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 GROGAN ST
Mailing Address - Street 2:
Mailing Address - City:LAVONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30553-1878
Mailing Address - Country:US
Mailing Address - Phone:706-988-7610
Mailing Address - Fax:
Practice Address - Street 1:795 GROGAN ST
Practice Address - Street 2:
Practice Address - City:LAVONIA
Practice Address - State:GA
Practice Address - Zip Code:30553-1878
Practice Address - Country:US
Practice Address - Phone:706-988-7610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT006394208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation