Jerusha Stacey, NP-P/MH

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

RN069963 Issued in GA

Practice address

212 Grady St
Thomasville, GA 31792-6123

Phone

(229) 225-4370

Fax

(229) 225-4374

NPI assigned

Mar 5, 2021

Last updated

Aug 12, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Georgia Pines Community Service BoardGroup PAC ID 5799772844, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Georgia Pines Community Service Board

  • Community/Behavioral Health Agency
  • Thomasville, GA
  • NPI 1366506958
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786492800000",
    "number": "1114512746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 624",
            "city": "OCHLOCKNEE",
            "state": "GA",
            "postal_code": "317730624",
            "telephone_number": "229-200-5916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 GRADY ST",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317926123",
            "telephone_number": "229-225-4370",
            "fax_number": "229-225-4374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACEY",
        "first_name": "JERUSHA",
        "credential": "NP-P/MH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-05",
        "last_updated": "2026-08-12",
        "certification_date": "2026-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN069963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southwestern State Hospital Community Services
• Yuri Leonardo Souza Borges Sr.
• Sovereign and Grace Services (A.R.K Diagnostics Solutions)
• Charles Garland Spann, M.D.
• Molly Moye Squires, CCC-SLP
• Leslie C. Stanaland, N.P.
• Sheila L Stanley, LPC
• Dawn Sampson Stapp, M ED. CCC-SLP
• Susan Kay Starling, RPH
• Amy Marie Starr, OTR/L

• Psychiatric/Mental Health Nurse Practitioner in Thomasville, GA
• Providers in Thomasville, GA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.