Provider Demographics
NPI:1922358027
Name:FEARS, STACEY LORRIANE (NP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LORRIANE
Last Name:FEARS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 ASHWORTH CIR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3204
Mailing Address - Country:US
Mailing Address - Phone:770-855-3229
Mailing Address - Fax:
Practice Address - Street 1:1003 OAK RD SW STE B
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-1826
Practice Address - Country:US
Practice Address - Phone:470-416-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-16
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN173878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily