Provider Demographics
NPI:1841360039
Name:STEPHENS, DAN BRYAN (MD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:BRYAN
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:140 VANN ST NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7297
Mailing Address - Country:US
Mailing Address - Phone:770-422-9799
Mailing Address - Fax:770-422-2872
Practice Address - Street 1:140 VANN ST NE
Practice Address - Street 2:SUITE 300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7297
Practice Address - Country:US
Practice Address - Phone:770-422-9799
Practice Address - Fax:770-422-2872
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA012372207VG0400X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Not Answered261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty