Provider Demographics
NPI:1639196348
Name:STOCKWELL, PRISCILLA L (NP)
Entity Type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:L
Last Name:STOCKWELL
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:PO BOX 116156
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6156
Mailing Address - Country:US
Mailing Address - Phone:678-312-5525
Mailing Address - Fax:770-339-2120
Practice Address - Street 1:1000 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7694
Practice Address - Country:US
Practice Address - Phone:678-312-3273
Practice Address - Fax:678-312-3282
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN071271363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I500146Medicare UPIN