Provider Demographics
NPI:1710670492
Name:STANCIL, JACEY DIAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JACEY
Middle Name:DIAN
Last Name:STANCIL
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:228 CLEARWATER CIR
Mailing Address - Street 2:
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-3311
Mailing Address - Country:US
Mailing Address - Phone:904-437-8260
Mailing Address - Fax:
Practice Address - Street 1:131 SILVERWOOD CT STE 100
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5131
Practice Address - Country:US
Practice Address - Phone:912-826-3927
Practice Address - Fax:912-826-3931
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA11643363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical