Provider Demographics
NPI:1679076525
Name:STOVER, DEBRA ANN (NP-C)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:STOVER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 SWIFT CREEK CT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-6054
Mailing Address - Country:US
Mailing Address - Phone:678-428-4070
Mailing Address - Fax:
Practice Address - Street 1:1350 SWIFT CREEK CT
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3005
Practice Address - Country:US
Practice Address - Phone:678-428-4070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN181848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily