Individual
BLAKE ALEXANDER STACEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2700 WAYNE MEMORIAL DR, GOLDSBORO, NC 27534-9494
(919) 736-1110
Mailing address
170 MANNING DR, CHAPEL HILL, NC 27514-4221
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2023-01786
NC
390200000X
Student in an Organized Health Care Education/Training Program
STAC-DRD3UN
NC
Other
Enumeration date
04/21/2021
Last updated
01/05/2025
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