Provider Demographics
NPI:1336901818
Name:ROBY, STACIE (BCDFH)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:ROBY
Suffix:
Gender:F
Credentials:BCDFH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 LEXINGTON PARKE DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-3732
Mailing Address - Country:US
Mailing Address - Phone:850-758-9685
Mailing Address - Fax:
Practice Address - Street 1:7977 HIGHWAY 92 STE F
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5612
Practice Address - Country:US
Practice Address - Phone:770-874-1044
Practice Address - Fax:770-866-0906
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach