Healthcare Provider Details

I. General information

NPI: 1336901818
Provider Name (Legal Business Name): STACIE ROBY BCDFH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7977 HIGHWAY 92 STE F
WOODSTOCK GA
30189-5612
US

IV. Provider business mailing address

126 LEXINGTON PARKE DR
WOODSTOCK GA
30189-3732
US

V. Phone/Fax

Practice location:
  • Phone: 770-874-1044
  • Fax: 770-866-0906
Mailing address:
  • Phone: 850-758-9685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: