Healthcare Provider Details

I. General information

NPI: 1225838998
Provider Name (Legal Business Name): STAYWELL HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 OVER LAKE DR SE STE B
CONYERS GA
30013-1788
US

IV. Provider business mailing address

1804 OVER LAKE DR SE STE B
CONYERS GA
30013-1788
US

V. Phone/Fax

Practice location:
  • Phone: 470-971-0062
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCIA PHILLIPS
Title or Position: PMHNP-BC
Credential:
Phone: 470-767-0094