Individual
STACY L WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
1007 CADDENWOODS DR, AUGUSTA, GA 30906-5618
(706) 751-4089
Mailing address
1007 CADDENWOODS DR, AUGUSTA, GA 30906-5618
(706) 751-4089
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
LCB201400000776
GA
Other
Enumeration date
06/13/2014
Last updated
06/13/2014
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