Individual
STACEY DARRISAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, CCM
Contact information
Practice address
2020 7TH AVE, COLUMBUS, GA 31904-8914
(762) 822-1242
(706) 494-4445
Mailing address
49 WESTWOOD WAY, FORTSON, GA 31808-6069
(762) 822-1242
(706) 494-4445
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
RN124631
GA
171M00000X
Case Manager/Care Coordinator
RN124631
GA
251B00000X
Case Management Agency
Primary
RN124631
GA
Other
Enumeration date
05/12/2020
Last updated
05/12/2020
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