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Individual

DR. STACEY WILLINGHAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
2774 N. COBB PKWY., SUITE 109, #133, KENNESAW, GA 30152-3334
(404) 964-1474
Mailing address
2774 N COBB PKWY, SUITE 109, #133, KENNESAW, GA 30152-3469

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
041426
GA

Other

Enumeration date
07/28/2008
Last updated
03/28/2012
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