Healthcare Provider Details

I. General information

NPI: 1659625085
Provider Name (Legal Business Name): STACEY M TURNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PERIMETER SUMMIT BLVD NE APT 2404
ATLANTA GA
30319-1481
US

IV. Provider business mailing address

10 PERIMETER SUMMIT BLVD NE APT 2404
ATLANTA GA
30319-1481
US

V. Phone/Fax

Practice location:
  • Phone: 404-964-9558
  • Fax:
Mailing address:
  • Phone: 404-964-9558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN142408
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: