Healthcare Provider Details

I. General information

NPI: 1497661177
Provider Name (Legal Business Name): STONE HARBOR MEDICAL MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 SAINT MARYS RD
SAINT MARYS GA
31558-4559
US

IV. Provider business mailing address

2828 SAINT MARYS RD
SAINT MARYS GA
31558-4559
US

V. Phone/Fax

Practice location:
  • Phone: 912-882-9320
  • Fax: 888-476-5235
Mailing address:
  • Phone: 912-882-9320
  • Fax: 888-476-5235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESSICA DYALS
Title or Position: SOLE MEMBER
Credential: APRN, FNP-C
Phone: 912-882-9320