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NPI Code Detail

MEDICARE: STACEY HODGES WILLIFORD NP

MEDICARE: STACEY HODGES WILLIFORD NP
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
1363L00000XNurse PractitionerRN149431GA
2163WG0000XGeneral Practice Registered NurseRN149431GA
3363LF0000XFamily Nurse PractitionerRN149431GA
4363LF0000XFamily Nurse PractitionerNP149431GA
5363L00000XNurse PractitionerAPRN-NP149431GA
6208D00000XGeneral Practice PhysicianNP149431GA

General Provider Information

NPI Number : 1740616721
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY HODGES WILLIFORD NP
Provider Business Mailing Address
First Line : 2173 MOUNT ZION RD
Second Line :
City : WARTHEN
State : GA
Zip : 31094-4259
Country : US
Telephone Number : 478-412-2880
Fax Number :
Provider Business Practice Location Address
First Line : 524 SPARTA RD
Second Line :
City : SANDERSVILLE
State : GA
Zip : 31082-1376
Country : US
Telephone Number : 478-412-2880
Fax Number : 478-412-2881
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2013
Last Update Date : 10/24/2025

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Directions to “ STACEY HODGES WILLIFORD NP” Practice Location

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