Provider Demographics
NPI:1760873624
Name:MAY, STACEY LAMAR (EXERCISE PHYSIOLOGY)
Entity Type:Individual
Prefix:MR
First Name:STACEY
Middle Name:LAMAR
Last Name:MAY
Suffix:
Gender:M
Credentials:EXERCISE PHYSIOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HUMBLE AVE STE 174
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-6329
Mailing Address - Country:US
Mailing Address - Phone:601-554-8520
Mailing Address - Fax:
Practice Address - Street 1:301 HUMBLE AVE STE 174
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-6329
Practice Address - Country:US
Practice Address - Phone:601-554-8520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator