Stacy D Roberts, B.S., D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CHIR007730 Issued in GA

Practice address

165 Rebel Rise
Fayetteville, GA 30215-5095

Phone

(470) 400-9431

Fax

(678) 669-1867

NPI assigned

Mar 9, 2006

Sex

Female

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

Enrollment records 1

Specialty

Chiropractic

Education

Logan College of Chiropractic, 2003

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Science

State licenses

Practice roles

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.

• Total Health, LLC

  • Chiropractor
  • Jonesboro, GA
  • NPI 1063950004
  Medicare reassignment Authorized official
• Fayette Chiropractic Center, Inc

  • Chiropractor
  • Jonesboro, GA
  • NPI 1114381175
  NPD (past)
• Fayette Chiropractic Center, Inc

  • Chiropractor
  • Peachtree City, GA
  • NPI 1205141264
  NPD (past)

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1720056476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 REBEL RISE",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302155095",
            "telephone_number": "470-400-9431",
            "fax_number": "678-669-1867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 REBEL RISE",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302155095",
            "telephone_number": "470-400-9431",
            "fax_number": "678-669-1867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "STACY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "B.S., D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-09",
        "last_updated": "2021-10-05",
        "certification_date": "2021-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "GA",
            "license": "CHIR007730",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR007730",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• RN Drip, LLC
• Emily Grace Crow Roberson, PHARMD
• Robert L Clemons II
• Amanda Victoria Roberts, PHARMD, RPH
• Marilyn Catherine Roberts, M.S. LPC
• Terrence Jawaan Roberts, O.D.
• Lavert None Robertson I, N.D.
• Michelle N. Robertson, M.A. CCC-SLP
• Anthony J Robinson, CSA
• Ariel Briana Robinson, RDN, LDN

• Chiropractor in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.