Individual
STACIE COLELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
802 HIGHWAY 119 SOUTH, SPRINGFIELD, GA 31329
(912) 754-6484
Mailing address
3229 GA HIGHWAY 119 N, PEMBROKE, GA 31321-5829
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN175700
GA
Other
Enumeration date
11/16/2017
Last updated
11/16/2017
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