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General NPI Number Information
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NPI Number | 1497661177
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Entity Type | Organization
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Legal Business Name | STONE HARBOR MEDICAL MANAGEMENT LLC
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Dates
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Enumeration Date | 08/21/2026
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Last Update Date | 08/21/2026
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Provider Practice Location Address
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Address Line | 2828 SAINT MARYS RD
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City | SAINT MARYS
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State | GA
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Zip | 31558-4559
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Country | US
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Telephone | 912-882-9320
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Fax | 888-476-5235
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Provider Business Mailing Address
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Address Line | 2828 SAINT MARYS RD
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City | SAINT MARYS
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State | GA
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Zip | 31558-4559
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Country | US
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Telephone | 912-882-9320
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Fax | 888-476-5235
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | JESSICA DYALS
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Credential | APRN, FNP-C
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Telephone | 912-882-9320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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