Provider Demographics
NPI:1053819565
Name:STANLEY, RENECIA
Entity Type:Individual
Prefix:
First Name:RENECIA
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 MULKEY RD APT 714
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8261
Mailing Address - Country:US
Mailing Address - Phone:567-315-0275
Mailing Address - Fax:
Practice Address - Street 1:1820 MULKEY RD APT 714
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8261
Practice Address - Country:US
Practice Address - Phone:567-315-0275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)