Provider Demographics
NPI:1982802013
Name:STATHAM, ANNIE DENISE (APRN-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:DENISE
Last Name:STATHAM
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEDICAL PARK WAY
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3656
Mailing Address - Country:US
Mailing Address - Phone:229-944-4031
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL PARK WAY
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3656
Practice Address - Country:US
Practice Address - Phone:229-944-4031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN111226363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily