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NPI Code Detail

MEDICARE: MALLORY D STINSON FNP-C

MEDICARE: MALLORY D STINSON FNP-C
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
1363LF0000XFamily Nurse PractitionerRN286644GA

General Provider Information

NPI Number : 1720976459
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALLORY D STINSON FNP-C
Provider Business Mailing Address
First Line : 59 TIPTON DR
Second Line :
City : DAHLONEGA
State : GA
Zip : 30533-1603
Country : US
Telephone Number : 770-800-3455
Fax Number : 770-450-8024
Provider Business Practice Location Address
First Line : 105 PROFESSIONAL PARK DR
Second Line :
City : CUMMING
State : GA
Zip : 30040-2381
Country : US
Telephone Number : 770-800-3455
Fax Number : 770-450-8024
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2025
Last Update Date : 12/02/2025

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Directions to “ MALLORY D STINSON FNP-C” Practice Location

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