STACEY BASQUIN (NPI# 1760549919) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760549919 |
| Entity Type | Individual |
| Full Name | STACEY BASQUIN |
| Credential | PAC |
| Practice Address |
1601 Fair Road Suite 600 Cotton Ridge Medical Plaza Statesboro GA 30458 |
| Mailing Address |
Po Box 1640 Statesboro GA 30459-1640 |
| Practice Telephone | 9126814911 |
| Practice Fax Number | 9126816911 |
| Mailing Telephone | 9126814911 |
| Mailing Fax Number | 9126816911 |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2020-09-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 4104GA | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1601 FAIR ROAD SUITE 600 COTTON RIDGE MEDICAL PLAZA |
| City | STATESBORO |
| State | GA |
| Zip Code | 30458 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184737728 | The Neurological Center of East Georgia PC | Psychiatry & Neurology | 1601 Fair Road, Suite 400 Cotton Ridge Medical Plaza, Statesboro, GA 30458-1699 | 2006-08-17 |
| 1710044557 | Andrew Vincent Cichelli | Internal Medicine | 1601 Fair Road, Suite 600 Cotton Ridge Medical Plaza, Statesboro, GA 30458 | 2007-01-02 |
| 1821166240 | Harsh Bhushan | Internal Medicine | 1601 Fair Road, #900, Statesboro, GA 30458 | 2006-12-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639642218 | Youtherapy | Counselor | 430 Northside Dr East, Suite 160 Mb326, Statesboro, GA 30458 | 2019-01-07 |
| 1053891853 | Alexandria Franklin | Specialist/Technologist | 1332 Southern Dr, Statesboro, GA 30458 | 2018-08-21 |
| 1740780006 | Michael Ryan Clark | Pharmacist | 556 Northside Drive, Statesboro, GA 30458 | 2018-02-13 |
| 1689186405 | Chandler James Herman | Specialist/Technologist | 590 Herty Dr., Statesboro, GA 30458 | 2017-11-02 |
| 1477009181 | Mama Doc Pediatrics, LLC | Pediatrics | 400 East Grady Street, Statesboro, GA 30458 | 2016-09-01 |
| 1053761171 | Rebekah Roessler | Specialist/Technologist | 2687 Akins Blvd, Statesboro, GA 30458 | 2016-06-20 |
| 1427412253 | Refocus Counseling and Consulting Services | Community/Behavioral Health | 4325 Country Club, 4, Statesboro, GA 30458 | 2016-04-07 |
| 1023408523 | Kacy H. Nesmith | Nurse Practitioner | 1098 Bermuda Run, Suite 6, Statesboro, GA 30458 | 2015-02-04 |
| 1760870398 | Jessica Pasternack | Specialist/Technologist | 2687 Akins Boulevard, Statesboro, GA 30458 | 2015-01-06 |
| 1922401629 | Nathan D'amico | Student in an Organized Health Care Education/Training Program | 15 W Grady Street Unit A, Statesboro, GA 30458 | 2014-10-08 |
| Find all providers in zip 30458 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265783260 | Neil Wesley Wilkerson | Physician Assistant | 1497 Fair Road, Suite 204, Statesboro, GA 30458 | 2012-10-01 |
| 1386919405 | Lauren Sack | Physician Assistant | 16915 Highway 67 Ste A, Statesboro, GA 30458-5819 | 2012-03-22 |
| 1245502269 | Toni Lynn Herring | Physician Assistant | 1161 Saralyn Ln, Suite A, Statesboro, GA 30461-7992 | 2012-02-07 |
| 1164530069 | Kathryn Ann Thatcher | Physician Assistant | 4002 Forest Dr, Statesboro, GA 30460-0001 | 2006-08-29 |
| 1144257379 | Karri O Ray | Physician Assistant | 1497 Fair Rd Ste 102, Statesboro, GA 30458 | 2006-06-26 |
| 1629634886 | Brittany Warren | Physician Assistant | 117 Hill Pond Ln, Statesboro, GA 30458 | 2019-05-14 |
| 1982168415 | Loretta Church | Physician Assistant | 1570 Brampton Ave, Statesboro, GA 30458-0855 | 2019-01-29 |
| 1083197107 | Jessica Ann Taylor | Physician Assistant | 19 Lester Rd, Statesboro, GA 30458-2119 | 2018-09-13 |
| 1013496439 | Jaimi Patel | Physician Assistant | 1523 Fair Rd, Statesboro, GA 30458-6025 | 2018-08-07 |
| 1619493517 | Cody Robert Ward | Physician Assistant | 1499 Fair Rd, Statesboro, GA 30458-1683 | 2017-08-22 |
| Find all providers in STATESBORO | ||||
| City | STATESBORO |
| Zip Code | 30458 |
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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.