Stacey Colebrook, RN
Individual provider Active NPI Registered Nurse · College Park, GA
NPI 1912189754 · NPPES record last updated Dec 4, 2007
Key facts
- NPI
- 1912189754
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- RN157462 (GA)
- Practice address
- 1919 John Wesley Ave
College Park, GA 30337-3605 - Phone
- (404) 762-9190
- Fax
- (404) 762-9101
- NPI assigned
- Dec 4, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN157462 | GA | MD | Addiction (Substance Use Disorder) Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Odyssey Family Counseling Center Corporation | Past |
Accepting new patients |
Interoperability endpoints
- https://api.qualifacts.org/api/fhir/odysseycounseling/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN157462 | GA | Yes |
| Addiction (Substance Use Disorder) Registered Nurse | 163WA0400X | RN157462 | GA | |
| Child & Adolescent Psychiatric/Mental Health Registered Nurse | 163WP0807X | RN157462 | GA |
Addresses
Primary practice location
1919 John Wesley Ave
College Park, GA 30337-3605
Mailing address
3578 S Fulton Ave
Hapeville, GA 30354-1756
Phone (404) 768-1156
Other providers in College Park, GA
- Cityviewhealthcare
- CJR Special Transportation LLC
- Clayton Pharma LLC
- Coastal Community Senior Living Services LLC
- Nyeshia Sherelle Cohill
- College Park Dialysis, LLC
- College Park Regional Health Center
- Yasmin Collier-Kenney
- Community Behavioral Center LLC
- Community Counseling & Resource Center Inc.
All providers in College Park, GA · Registered Nurse in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 4, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.