Provider Demographics
NPI:1356102123
Name:FRENCH, STACEY P
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:P
Last Name:FRENCH
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 1:136 MEMORIAL ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4684
Mailing Address - Country:US
Mailing Address - Phone:770-203-6349
Mailing Address - Fax:
Practice Address - Street 1:136 MEMORIAL ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4684
Practice Address - Country:US
Practice Address - Phone:770-203-6349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider