Individual
STACEY A HERTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAAA
Contact information
Practice address
1365 CLIFTON RD NE, ATLANTA, GA 30322-1013
(404) 778-4852
Mailing address
550 PEACHTREE ST NE BLDG 2ND, ATLANTA, GA 30308-2247
(404) 686-2316
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
2690
GA
367H00000X
Anesthesiologist Assistant
002690
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10000327A
—
GA
Enumeration date
07/11/2006
Last updated
11/10/2022
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