MEDICARE: STACY-LEE MELEISIA BUCHANAN-BROMLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	287824	GA

General Provider Information

NPI Number	:	1285596866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY-LEE MELEISIA BUCHANAN-BROMLEY

Provider Business Mailing Address
First Line	:	113 W RIVER CANE RUN
Second Line	:
City	:	PERRY
State	:	GA
Zip	:	31069-9470
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 W RIVER CANE RUN
Second Line	:
City	:	PERRY
State	:	GA
Zip	:	31069-9470
Country	:	US
Telephone Number	:	470-439-1396
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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Directions to “ STACY-LEE MELEISIA BUCHANAN-BROMLEY ” Practice Location

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