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General NPI Number Information
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NPI Number | 1164843389
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Entity Type | Individual
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Provider Name | STACEY A O'BRIEN MD
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Gender | Female
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Dates
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Enumeration Date | 12/16/2013
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Last Update Date | 10/02/2019
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Provider Practice Location Address
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Address Line | 14205 HIGHWAY 92 STE 105
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City | WOODSTOCK
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State | GA
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Zip | 30188-7138
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Country | US
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Telephone | 678-293-7854
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Fax |
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Provider Business Mailing Address
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Address Line | 1240 EAGLES LANDING PKWY SUITE 110
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-5170
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Country | US
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Telephone | 770-389-3855
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Fax | 770-474-8078
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L.3872R
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 73828
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License Number State | GA
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