Stacey Joy Haynes McClintick

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

0101261652 Issued in VA

Practice address

2480 Llewellyn Ave
Ft. Meade, MD 20755

Phone

(912) 349-9945

NPI assigned

Apr 1, 2015

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 VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1427846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721260800000",
    "number": "1871988337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1061 HARMON AVE",
            "city": "FORT STEWART",
            "state": "GA",
            "postal_code": "313145641",
            "telephone_number": "912-435-6965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2480 LLEWELLYN AVE",
            "city": "FT. MEADE",
            "state": "MD",
            "postal_code": "20755",
            "telephone_number": "912-349-9945"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8901 Wisconsin Ave",
            "address_purpose": "LOCATION",
            "city": "Bethesda",
            "state": "MD",
            "postal_code": "208895600",
            "country_code": "US",
            "telephone_number": "301-319-8373",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1061 Harmon Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Stewart",
            "state": "GA",
            "postal_code": "313145641",
            "country_code": "US",
            "telephone_number": "912-435-6965",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCLINTICK",
        "first_name": "STACEY JOY",
        "middle_name": "HAYNES",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-01",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101261652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Elizabeth Malis, LCSW
• Gail Lynn Marston, M.D.
• Logan Dishawn Mathus, PTT
• Daisuke Matsuo
• Samantha Beth McCann, DMD
• Marnecia McCoy, LICSW, LCSW-C
• Randy Daniel McDonald, CRNA
• Teresa Ann McDowell, LMSW
• Gregory M McKenna, DPT
• Mabel Zandra Metzger, CRNP

• Internal Medicine Physician in Ft. Meade, MD
• Providers in Ft. Meade, MD by specialty
• Internal Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.