Healthcare Provider Details

I. General information

NPI: 1467281287
Provider Name (Legal Business Name): MARCIA WYNN STOLER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 07/30/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LEE HEALTH CENTER 118 ROBERT B. LEE DR
LEESBURG GA
31763
US

IV. Provider business mailing address

204 N. WESTOVER BLVD
ALBANY GA
31707
US

V. Phone/Fax

Practice location:
  • Phone: 229-759-6508
  • Fax:
Mailing address:
  • Phone: 229-405-6249
  • Fax: 229-329-4373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH004242
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: