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NPI Code Detail

MEDICARE: STACEY H WILLIFORD LLC

MEDICARE: STACEY H WILLIFORD LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner
2208D00000XGeneral Practice Physician
3363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1447987227
Entity Type Code : Organization
Provider Name (Legal Business Name) : STACEY H WILLIFORD LLC
Provider Business Mailing Address
First Line : 524 SPARTA RD
Second Line :
City : SANDERSVILLE
State : GA
Zip : 31082-1376
Country : US
Telephone Number : 478-412-2880
Fax Number : 478-412-2881
Provider Business Practice Location Address
First Line : 524 SPARTA RD
Second Line :
City : SANDERSVILLE
State : GA
Zip : 31082-1376
Country : US
Telephone Number : 478-412-2880
Fax Number : 478-412-2881
Authorized Official
Title or Position : OWNER
Name : STACEY WILLIFORD
Credential : NP
Telephone Number : 478-232-7066
Provider Enumeration Date : 08/02/2022
Last Update Date : 10/24/2025

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