Stacey Willingham, M.D.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

041426 Issued in GA

Practice address

2774 N. Cobb Pkwy.
Suite 109, #133
Kennesaw, GA 30152-3334

Phone

(404) 964-1474

NPI assigned

Jul 28, 2008

Sex

Female

Sole proprietor

Yes

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

• Acworth Pain Management Center Inc

  • Pain Clinic/Center
  • Acworth, GA
  • NPI 1235354218
  NPD (past)
• Dana Health and Wellness Center Inc

  • General Practice Physician
  • Duluth, GA
  • NPI 1063823581
  NPD (past)
• Pain Consultants of Georgia LLC

  • Pain Medicine Physician
  • Lawrenceville, GA
  • NPI 1497052146
  NPD (past)
• Theradox

  • Multi-Specialty Clinic/Center
  • East Point, GA
  • NPI 1811304884
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1217203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332892800000",
    "number": "1144485293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2774 N COBB PKWY",
            "address_2": "SUITE 109, #133",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301523469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2774 N. COBB PKWY.",
            "address_2": "SUITE 109, #133",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301523334",
            "telephone_number": "404-964-1474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLINGHAM",
        "first_name": "STACEY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-28",
        "last_updated": "2012-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "GA",
            "license": "041426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leslie Beth Williams
• Mya L Williams, APRN
• Olivia Williams
• Olivia Kate Williams
• Anjali Williamson, DDS
• Willis Chiropractic Center LLC
• Willis Family Chiropractic, LLC
• Amy Dee Willis, D.C.
• Justin Kyle Willis, D.C.
• Nancy Kay Willis, D.C.

• All providers in Kennesaw, GA
• Physical Medicine & Rehabilitation Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.