MEDICARE: DR. BARRY CARTER STACEY D.M.D.

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
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	007936	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DN007936	OTHER	GA	GA STATE LICENSE

General Provider Information

NPI Number	:	1790848240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY CARTER STACEY D.M.D.

Provider Business Mailing Address
First Line	:	5041 DALLAS HWY
Second Line	:	BUILDING 2 SUITE A
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-6458
Country	:	US
Telephone Number	:	770-429-5507
Fax Number	:	770-429-5525

Provider Business Practice Location Address
First Line	:	5041 DALLAS HWY
Second Line	:	BUILDING 2 SUITE A
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-6458
Country	:	US
Telephone Number	:	770-429-5507
Fax Number	:	770-429-5525

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. BARRY CARTER STACEY D.M.D.” Practice Location

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