Provider Demographics
NPI:1558660381
Name:PICKELMAN, STACY LEIGH (AUD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LEIGH
Last Name:PICKELMAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 JOHNSON FERRY RD
Mailing Address - Street 2:STE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1601
Mailing Address - Country:US
Mailing Address - Phone:404-943-0900
Mailing Address - Fax:404-943-1390
Practice Address - Street 1:960 JOHNSON FERRY RD
Practice Address - Street 2:STE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1601
Practice Address - Country:US
Practice Address - Phone:404-943-0900
Practice Address - Fax:404-943-1390
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003898237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
46-2452924OtherITIN