Individual
STANLEY EDGAR UNDERWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGACNP
Contact information
Practice address
638 HISTORIC HWY 441 SUITE B, DEMOREST, GA 30535-4561
(770) 534-2020
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN254470
GA
363LA2100X
Acute Care Nurse Practitioner
Primary
APRN-NP254470
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/20/2024
Last updated
10/12/2025
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