Basic Information
| Provider Information | |||||||||
| NPI: | 1750350237 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | RONALD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 658 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305030658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707181122 | ||||||||
| FaxNumber: | 7705357445 | ||||||||
| Practice Location | |||||||||
| Address1: | 3400 OLD MILTON PKWY STE 190 | ||||||||
| Address2: | |||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300053707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706631100 | ||||||||
| FaxNumber: | 7706631101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 02/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | SF068421 | MI | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 062037 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 003107001D | 05 | GA | MEDICAID | 4352496 | 05 | MI | MEDICAID | 52305563 | 01 | GA | BCBS | OTHER | 7337297 | 01 | GA | AETNA | OTHER | 003107001B | 05 | GA | MEDICAID | 8306576 | 01 | GA | CIGNA | OTHER | 003107001A | 05 | GA | MEDICAID | 2151393 | 01 | GA | UNITEH HEALTHCARE | OTHER | 003107001C | 05 | GA | MEDICAID | 003107001E | 05 | GA | MEDICAID |