Healthcare Provider Details

I. General information

NPI: 1083234322
Provider Name (Legal Business Name): STACI THOMAS BENNETT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACI THOMAS COX

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 1ST ST STE 410
MACON GA
31201-8306
US

IV. Provider business mailing address

800 1ST ST STE 410
MACON GA
31201-8306
US

V. Phone/Fax

Practice location:
  • Phone: 478-743-7068
  • Fax: 478-743-4297
Mailing address:
  • Phone: 478-320-4644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP193050
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: