Healthcare Provider Details

I. General information

NPI: 1558660381
Provider Name (Legal Business Name): STACY LEIGH PICKELMAN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 JOHNSON FERRY RD STE 200
ATLANTA GA
30342-1601
US

IV. Provider business mailing address

960 JOHNSON FERRY RD STE 200
ATLANTA GA
30342-1601
US

V. Phone/Fax

Practice location:
  • Phone: 404-943-0900
  • Fax: 404-943-1390
Mailing address:
  • Phone: 404-943-0900
  • Fax: 404-943-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAUD003898
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: