Provider Demographics
NPI:1376650457
Name:THALASSITES, STACY ANN (NP-C)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:ANN
Last Name:THALASSITES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 BIRCHMORE CV
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-4587
Mailing Address - Country:US
Mailing Address - Phone:954-235-1125
Mailing Address - Fax:
Practice Address - Street 1:2277 BIRCHMORE CV
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-4587
Practice Address - Country:US
Practice Address - Phone:954-235-1125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1709122 NP-C282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital