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NPI Code Detail

MEDICARE: STACEY BASQUIN PAC

MEDICARE: STACEY BASQUIN PAC
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
1363A00000XPhysician Assistant4104GAGA

General Provider Information

NPI Number : 1760549919
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY BASQUIN PAC
Provider Business Mailing Address
First Line : PO BOX 689022
Second Line :
City : FRANKLIN
State : TN
Zip : 37068-9022
Country : US
Telephone Number : 615-465-7211
Fax Number : 615-628-6877
Provider Business Practice Location Address
First Line : 1601 FAIR RD STE 600
Second Line :
City : STATESBORO
State : GA
Zip : 30458-0800
Country : US
Telephone Number : 912-681-4911
Fax Number : 912-681-6911
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2007
Last Update Date : 02/09/2026

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Directions to “ STACEY BASQUIN PAC” Practice Location

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