Healthcare Provider Details

I. General information

NPI: 1538483185
Provider Name (Legal Business Name): STACI REBECCA PAYNE QUINTANA CD(DONA)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 WESLEY CHAPEL RD
DANIELSVILLE GA
30633-3529
US

IV. Provider business mailing address

PO BOX 278
ILA GA
30647-0278
US

V. Phone/Fax

Practice location:
  • Phone: 706-296-4857
  • Fax: 706-789-2578
Mailing address:
  • Phone: 706-296-4857
  • Fax: 706-789-2578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: