Healthcare Provider Details

I. General information

NPI: 1861425258
Provider Name (Legal Business Name): STACEY A CRESSY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 HOSPITAL SOUTH DR SUITE 500
AUSTELL GA
30106-6810
US

IV. Provider business mailing address

1230 COMMONWEALTH AVE SW
MARIETTA GA
30064-3750
US

V. Phone/Fax

Practice location:
  • Phone: 770-941-7717
  • Fax:
Mailing address:
  • Phone: 770-726-9029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN139554
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: