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General NPI Number Information
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NPI Number | 1922358027
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Entity Type | Individual
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Provider Name | STACEY LORRIANE FEARS NP
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Gender | Female
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Dates
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Enumeration Date | 09/16/2012
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 1003 OAK RD SW STE B
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City | LILBURN
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State | GA
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Zip | 30047-1826
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Country | US
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Telephone | 470-416-1515
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Fax |
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Provider Business Mailing Address
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Address Line | 2732 ASHWORTH CIR
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City | SNELLVILLE
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State | GA
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Zip | 30078-3204
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Country | US
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Telephone | 770-855-3229
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN173878
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License Number State | GA
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