Healthcare Provider Details

I. General information

NPI: 1548613987
Provider Name (Legal Business Name): SEQUENCE TO HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 OAK RD SW UNIT 1
LILBURN GA
30047-1891
US

IV. Provider business mailing address

1001 OAK RD SW UNIT 1
LILBURN GA
30047-1891
US

V. Phone/Fax

Practice location:
  • Phone: 470-416-1515
  • Fax: 949-695-4810
Mailing address:
  • Phone: 470-416-1515
  • Fax: 949-695-4810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. STACEY LORRIANE FEARS
Title or Position: NURSE PRACTITIONER
Credential: DNP, FNP-C, PMHNP-BC
Phone: 470-416-1515