Healthcare Provider Details

I. General information

NPI: 1710811849
Provider Name (Legal Business Name): STACEY SANHUEZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 W WALNUT AVE STE 1
DALTON GA
30720-3812
US

IV. Provider business mailing address

1508 CALLOWAY DR UNIT 3
DALTON GA
30721-0626
US

V. Phone/Fax

Practice location:
  • Phone: 706-934-3206
  • Fax:
Mailing address:
  • Phone: 706-934-3206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP232755
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: