Shantorius Shantae Stacks, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN-NP256370 Issued in GA

Practice address

2219 Benidorm CT
Atlanta, GA 30349-8497

Phone

(770) 572-7109

NPI assigned

Mar 29, 2023

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, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellstreet of Georgia PCGroup PAC ID 7517126279, 425 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Wellstreet of Georgia PC

  dba Piedmont Urgent Care

  • Urgent Care Clinic/Center
  • Newnan, GA
  • NPI 1235411547
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1680048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761696000000",
    "number": "1790489961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2219 BENIDORM CT",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303498497",
            "telephone_number": "770-572-7109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2219 BENIDORM CT",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303498497",
            "telephone_number": "770-572-7109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACKS",
        "first_name": "SHANTORIUS",
        "middle_name": "SHANTAE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-29",
        "last_updated": "2025-10-29",
        "certification_date": "2025-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "APRN-NP256370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elvenique St.Cyr
• Stuart Worth St.George, LCSW
• Latasha R Stabler, MD
• Stacie Cook and Associates,LLC
• Karen D Stack, RN BSN MN
• L David Stacy Jr., M.D.
• William M Stader, R.T.
• Lisa Arnell Stafford-Johnson, DC
• Chaundia Ciarra Kanaye Stafford
• Cleo Dennis Stafford II, M.D.

• Family Nurse Practitioner in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2025; 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.