STACY WIDEMAN (NPI# 1386243871) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386243871 |
| Entity Type | Individual |
| Full Name | STACY WIDEMAN |
| Practice Address |
5775 Peachtree Dunwoody Rd Ste C200 Atlanta GA 30342-1509 |
| Practice Telephone | 6784262930 |
| Mailing Telephone | 6784262930 |
| Enumeration Date | 2020-10-26 |
| Last Update Date | 2020-10-26 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
RN225736 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
5775 PEACHTREE DUNWOODY RD STE C200 |
| City | ATLANTA |
| State | GA |
| Zip Code | 30342-1509 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952819179 | Atlanta Acupuncture and Chinese Medicine | Acupuncturist | 5775 Peachtree Dunwoody Rd Ste C200, Atlanta, GA 30342-1509 | 2018-01-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144820614 | Nia Charnice Griffin | Nurse Practitioner | 5670 Peachtree Dunwoodyroad, Suite 900, Atlanta, GA 30342 | 2020-10-26 |
| 1255945184 | Jennifer Lynne Cole | Behavior Technician | 5555 Glenridge Con Suite 200, Atlanta, GA 30342 | 2020-09-08 |
| 1093336232 | Van Tran | Respiratory Therapist, Registered | 1000 Johnson Ferry Rd Ne, Atlanta, Ga 30342, Atlanta, GA 30342 | 2020-04-28 |
| 1356978340 | Twyla Douglas Jackson I | Clinical Nutrition, 1000 Johnson Ferry Rd Ne, Atlanta, GA 30342 | 2020-03-27 | |
| 1760013411 | Emily Hamm | Dietitian, Registered | 933 D Johnson Ferry Road, Suite 250, Atlanta, GA 30342 | 2020-01-31 |
| 1043855984 | Mackenzie Tucker Wayda | Registered Nurse | 1001 Johnson Ferry Rd. Ne, Atlanta, GA 30342 | 2019-11-14 |
| 1386288454 | Tiauna Lashun Cochman | Psychologist | 1307 Glenridge Dr, Sandy Springs, GA 30342 | 2019-11-01 |
| 1164074399 | Stephen J. White | Hearing Instrument Specialist | 5775 Peachtree Dunwoody Rd Suite 600 Fl. 6, Uhc Hearing, Atl., GA 30342 | 2019-07-09 |
| 1144788142 | Jaytyn LLC | Internal Medicine | 4600 Broswell Road, Atlanta, GA 30342 | 2019-03-08 |
| 1760954705 | Mishele Walker LLC | Counselor | 555 Glenridge Connector, Suite 200, Sandy Springs, GA 30342 | 2018-12-31 |
| Find all providers in zip 30342 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659989549 | Bosede Omolara Babalola-adejokun | Nurse Practitioner | 160 Magnolia Walk Ln, Atlanta, GA 30349-4067 | 2020-07-16 |
| 1891313276 | Health Medix Center Inc | Nurse Practitioner | 5401 Boreal Way Sw, Atlanta, GA 30331-9215 | 2020-07-11 |
| 1831736826 | Carol Lorraine Borchers | Nurse Practitioner | 3648 Peachtree Rd Ne Apt 1j, Atlanta, GA 30319-1271 | 2019-12-09 |
| 1033606165 | Jane Wanjiru Waweru | Nurse Practitioner | 635 Windy Ridge Ln Se, Atlanta, GA 30339-2438 | 2018-04-14 |
| 1780198820 | Joanne Patrice Parks | Nurse Practitioner | 3110 Henderson Walk, Atlanta, GA 30340-4329 | 2017-11-28 |
| 1013467570 | Jill Morich Webb | Nurse Practitioner | 2150 Peachford Rd Ste Q, Atlanta, GA 30338-6539 | 2016-10-09 |
| 1518413897 | Terre Cheely | Nurse Practitioner | 2 Ravinia Drive Suite 500, Atlanta, GA 30346 | 2016-08-28 |
| 1407211964 | Donna D. Wilson | Nurse Practitioner | 35 Collier Rd Nw Ste 425, Atlanta, GA 30309-1613 | 2015-12-28 |
| 1265785596 | Shikira Mone' Woods | Nurse Practitioner | 101 Marietta St Nw Ste 350, Atlanta, GA 30303-2724 | 2012-10-24 |
| 1104846385 | Elizabeth L Robinson | Nurse Practitioner | 289 Little St Se, Atlanta, GA 30315-1364 | 2006-07-20 |
| Find all providers in ATLANTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.