Provider Demographics
NPI:1225249691
Name:PACE, STACEY STARR (MD)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:STARR
Last Name:PACE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BUGTUSSLE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334
Mailing Address - Country:US
Mailing Address - Phone:931-438-8708
Mailing Address - Fax:
Practice Address - Street 1:1931 WILSON PKY
Practice Address - Street 2:SUITE A
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334
Practice Address - Country:US
Practice Address - Phone:931-438-8708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000031614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine