Basic Information
| Provider Information | |||||||||
| NPI: | 1487292694 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | STELLA | ||||||||
| MiddleName: | ROYETTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 MEADOW OVERLOOK DR | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300165937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072526137 | ||||||||
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| Practice Location | |||||||||
| Address1: | 275 CARPENTER DR | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303284928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8446444325 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2019 | ||||||||
| LastUpdateDate: | 05/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN225738 | GA | N | Nursing Service Providers | Registered Nurse | 363L00000X | RN225738 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.