Provider Demographics
NPI:1841842580
Name:DEAKINS, STACIA (PTA)
Entity type:Individual
Prefix:
First Name:STACIA
Middle Name:
Last Name:DEAKINS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:STACIA
Other - Middle Name:
Other - Last Name:HAWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1901 W SCREVEN ST
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31643-3913
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1901 W SCREVEN ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643-3913
Practice Address - Country:US
Practice Address - Phone:229-263-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA004009225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant