Provider Demographics
NPI:1861837072
Name:HAMLEY, STACIE NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:NICOLE
Last Name:HAMLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 MOUNT VERNON HWY NE STE 150
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4289
Mailing Address - Country:US
Mailing Address - Phone:404-303-1314
Mailing Address - Fax:
Practice Address - Street 1:755 MOUNT VERNON HWY NE STE 150
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4289
Practice Address - Country:US
Practice Address - Phone:404-303-1314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101260604208000000X
KS04-39304208000000X
GA77687208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics