David E Stidham, FPMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

RN139536 Issued in GA

Practice address

1905 S Hutchinson Ave
Adel, GA 31620-5246

Phone

(229) 896-4559

Fax

(229) 896-8367

NPI assigned

Jun 1, 2018

Last updated

Sep 27, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Behavioral Health Services of South GeorgiaGroup PAC ID 0840181426, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Behavioral Health Services of South Georgia

  dba Behavioral Health Services of S GA

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Valdosta, GA
  • NPI 1801932371
  Medicare reassignment Care Compare group NPD
• Behavioral Health Crisis Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Valdosta, GA
  • NPI 1518396548
  NPD (past)
• SSSS

  • Clinic/Center
  • Nashville, GA
  • NPI 1922557792
  NPD (past)

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

{
    "created_epoch": "1527811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632700800000",
    "number": "1700378049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 N OAK STREET EXT STE C",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316025910",
            "telephone_number": "229-896-4559",
            "fax_number": "229-896-8367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 S HUTCHINSON AVE",
            "city": "ADEL",
            "state": "GA",
            "postal_code": "316205246",
            "telephone_number": "229-896-4559",
            "fax_number": "229-896-8367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STIDHAM",
        "first_name": "DAVID",
        "middle_name": "E",
        "name_prefix": "Mr.",
        "credential": "FPMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-01",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN139536",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN139536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southern Roots DPC LLC
• Southland Adel Emergency Services, LLC.
• Sowega Home Health Care, Inc. (Comfort Keepers)
• Monica Lynn Stalvey, LPC
• Stephanie Renee's Salon and Med Spa
• Kayla Stone, OTR/L
• Walter Stone, NP
• Suncrest Home Health of South Ga, Inc. (Crescent Home Health)
• Amanda Kathleen Taylor
• Thomas D Fausett Jr MD PC

• Psychiatric/Mental Health Nurse Practitioner in Adel, GA
• Providers in Adel, 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 Sep 27, 2021; 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.