Healthcare Provider Details

I. General information

NPI: 1083469233
Provider Name (Legal Business Name): CHANCE STODGHILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 CLIFTON RD NE
ATLANTA GA
30322-4200
US

IV. Provider business mailing address

108 CLEARWATER DR
JACKSON GA
30233-3834
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-7551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License NumberRN307755
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: