Healthcare Provider Details

I. General information

NPI: 1427825579
Provider Name (Legal Business Name): LITTLE MOUNTAIN CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 TRIBBLE GAP RD
ALTO GA
30510-2113
US

IV. Provider business mailing address

7505 TRIBBLE GAP RD
ALTO GA
30510-2113
US

V. Phone/Fax

Practice location:
  • Phone: 706-499-2319
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HALEY STAPLETON
Title or Position: OWNER
Credential:
Phone: 678-227-9219