Healthcare Provider Details

I. General information

NPI: 1225377245
Provider Name (Legal Business Name): STACY WHYTE-PIERRE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2274 SALEM RD SE STE 106-1273
CONYERS GA
30013-2097
US

IV. Provider business mailing address

2274 SALEM RD SE STE 106-1273
CONYERS GA
30013-2097
US

V. Phone/Fax

Practice location:
  • Phone: 678-898-9194
  • Fax:
Mailing address:
  • Phone: 770-728-8723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN195161
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number584435
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP195161
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: