Healthcare Provider Details

I. General information

NPI: 1346539335
Provider Name (Legal Business Name): ERIKA CHARISE STUBBS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4798 FLAT SHOALS PKWY
DECATUR GA
30034-5205
US

IV. Provider business mailing address

4258 LINECREST LN
ELLENWOOD GA
30294-6901
US

V. Phone/Fax

Practice location:
  • Phone: 770-808-7788
  • Fax:
Mailing address:
  • Phone: 678-887-0645
  • Fax: 404-244-3603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 137244
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberRN 137244
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License NumberRN 137244
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN 137244
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN 137244
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License NumberRN 137244
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: