Provider Demographics
NPI:1063692895
Name:ANDREWS, STACIE S (MS, PT)
Entity type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:S
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 ASHVILLE CT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1669
Mailing Address - Country:US
Mailing Address - Phone:478-474-4035
Mailing Address - Fax:478-474-7713
Practice Address - Street 1:220 MARGIE DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7813
Practice Address - Country:US
Practice Address - Phone:478-474-4035
Practice Address - Fax:478-474-7713
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA193449608BMedicaid