Provider Demographics
NPI:1497446868
Name:STANSELL, COURTNEY JEANNE (BS, ED)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JEANNE
Last Name:STANSELL
Suffix:
Gender:F
Credentials:BS, ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 REDHEAD LN
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-5409
Mailing Address - Country:US
Mailing Address - Phone:770-597-0773
Mailing Address - Fax:
Practice Address - Street 1:204 RESOURCE LN
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-8361
Practice Address - Country:US
Practice Address - Phone:678-963-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14441601390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program