Healthcare Provider Details

I. General information

NPI: 1942037957
Provider Name (Legal Business Name): ABIGAIL STACY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6884 HICKORY RD
WOODSTOCK GA
30188-6581
US

IV. Provider business mailing address

6225 SMOKE RIDGE LN
CUMMING GA
30041-3035
US

V. Phone/Fax

Practice location:
  • Phone: 770-704-8244
  • Fax:
Mailing address:
  • Phone: 317-850-3393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017407
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: