Healthcare Provider Details

I. General information

NPI: 1447772918
Provider Name (Legal Business Name): STACIA ANN FRITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 CHAMBLEE TUCKER RD BLDG 16
ATLANTA GA
30341-4148
US

IV. Provider business mailing address

2900 CHAMBLEE TUCKER RD BLDG 16
ATLANTA GA
30341-4148
US

V. Phone/Fax

Practice location:
  • Phone: 770-939-1288
  • Fax: 770-212-2203
Mailing address:
  • Phone: 770-939-1288
  • Fax: 770-212-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8509
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: