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General NPI Number Information
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NPI Number | 1447987227
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Entity Type | Organization
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Legal Business Name | STACEY H WILLIFORD LLC
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Dates
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Enumeration Date | 08/02/2022
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 524 SPARTA RD
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City | SANDERSVILLE
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State | GA
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Zip | 31082-1376
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Country | US
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Telephone | 478-412-2880
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Fax | 478-412-2881
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Provider Business Mailing Address
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Address Line | 524 SPARTA RD
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City | SANDERSVILLE
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State | GA
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Zip | 31082-1376
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Country | US
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Telephone | 478-412-2880
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Fax | 478-412-2881
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Authorized Official
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Title or Position | OWNER
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Name | STACEY WILLIFORD
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Credential | NP
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Telephone | 478-232-7066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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