Provider Demographics
NPI:1396382321
Name:BRINKLEY, STACEY
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:BRINKLEY
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 1:3725 PRINCETON LAKES PKWY SW APT 7304
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5564
Mailing Address - Country:US
Mailing Address - Phone:229-630-8597
Mailing Address - Fax:
Practice Address - Street 1:3725 PRINCETON LAKES PKWY SW APT 7304
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5564
Practice Address - Country:US
Practice Address - Phone:229-630-8597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN174264363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily