Healthcare Provider Details

I. General information

NPI: 1316601446
Provider Name (Legal Business Name): STACEY SINCLAIR DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 HOWELL MILL RD NW STE B2
ATLANTA GA
30318-3117
US

IV. Provider business mailing address

6397 LEE HWY
CHATTANOOGA TN
37421-2564
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-5432
  • Fax:
Mailing address:
  • Phone: 423-238-3473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCPOO7859T
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: