Provider Demographics
NPI:1023581642
Name:STACKS, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:STACKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2213
Mailing Address - Country:US
Mailing Address - Phone:803-347-2105
Mailing Address - Fax:
Practice Address - Street 1:567 HAMPTON DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2213
Practice Address - Country:US
Practice Address - Phone:803-347-2105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management