MEDICARE: STACIE SHARET RICE FNP-BC, MSN-ED, RN

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	363L00000X	Nurse Practitioner	RN227934	GA

General Provider Information

NPI Number	:	1942965496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACIE SHARET RICE FNP-BC, MSN-ED, RN

Provider Business Mailing Address
First Line	:	PO BOX 6298
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30722-6298
Country	:	US
Telephone Number	:	423-310-1642
Fax Number	:

Provider Business Practice Location Address
First Line	:	1372 PEACHTREE ST NE STE 100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-3203
Country	:	US
Telephone Number	:	470-964-1700
Fax Number	:

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

Provider Enumeration Date	:	11/01/2021
Last Update Date	:	10/31/2023

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