MEDICARE: DR. STACEY LEAH SWEET PSY.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	103TC0700X	Clinical Psychologist	PSY002714	GA

General Provider Information

NPI Number	:	1912083320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEY LEAH SWEET PSY.D.

Provider Business Mailing Address
First Line	:	1882 PRINCETON AVE STE 3
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30337-3536
Country	:	US
Telephone Number	:	404-274-1219
Fax Number	:	404-996-1220

Provider Business Practice Location Address
First Line	:	1882 PRINCETON AVE STE 3
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30337-3536
Country	:	US
Telephone Number	:	404-274-1219
Fax Number	:	404-996-1220

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	04/20/2012

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