Provider Demographics
NPI:1528066172
Name:STEPHENSON, GEORGIA S (MD)
Entity type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:S
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14807 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-3708
Mailing Address - Country:US
Mailing Address - Phone:210-495-2020
Mailing Address - Fax:210-495-4500
Practice Address - Street 1:14807 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3708
Practice Address - Country:US
Practice Address - Phone:210-495-2020
Practice Address - Fax:210-495-4500
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4138207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7697457OtherAETNA
TX1538381-03Medicaid
TX9152935OtherCIGNA
TX7697457OtherAETNA