Provider Demographics
NPI:1598471286
Name:WINT-BARNES, STACYANN
Entity Type:Individual
Prefix:
First Name:STACYANN
Middle Name:
Last Name:WINT-BARNES
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 1:601 COLEMAN ST
Mailing Address - Street 2:
Mailing Address - City:HAPEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1041
Mailing Address - Country:US
Mailing Address - Phone:678-683-5435
Mailing Address - Fax:
Practice Address - Street 1:601 COLEMAN ST
Practice Address - Street 2:
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-1041
Practice Address - Country:US
Practice Address - Phone:770-703-1785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health