# DESTINY MEDICAL SERVICES, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508293465
- **Authorized official:** DR. STACEY WILLINGHAM (CEO')
- **Authorized official phone:** (404) 964-1474

## Contact information

- **Practice address:** 2804 N OAK ST, VALDOSTA, GA 31602-5914
- **Practice address phone:** (229) 241-8925
- **Practice address fax:** (229) 241-9165
- **Mailing address:** 2774 N COBB PKWY, SUITE 109, \#133, KENNESAW, GA 30152-3469

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 41426 | GA | Yes |

## Other

- **Enumeration date:** 10/08/2013
- **Last updated:** 10/08/2013