Provider Demographics
NPI:1366993149
Name:EBERHART, STACY (NNP-BC)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:EBERHART
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 COUNTY ROAD 816
Mailing Address - Street 2:
Mailing Address - City:WEDOWEE
Mailing Address - State:AL
Mailing Address - Zip Code:36278-6234
Mailing Address - Country:US
Mailing Address - Phone:404-376-5801
Mailing Address - Fax:
Practice Address - Street 1:800 KENNESAW AVE NW STE 200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7940
Practice Address - Country:US
Practice Address - Phone:706-272-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA189163363LN0000X, 363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal