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Mallory Stavrinakis

Nurse Practitioner in Atlanta, GA. Individual provider (NPI-1).

NPI number1154881969
StatusActive
Last updated in NPPESApr 28, 2022

Details

NPI
1154881969
Entity type
Individual (NPI-1)
Name
Mallory Stavrinakis
Sex
Female
Sole proprietor
Yes
Enumeration date
Mar 20, 2019
Certification date
Apr 28, 2022
Last updated
Apr 28, 2022

Medicare and OIG

Medicare enrolled (PECOS)
Yes · PRACTITIONER - NURSE PRACTITIONER
Can order and refer
Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
OIG exclusion list
This NPI is not listed

CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363L00000X Nurse Practitioner5014947NCYes
163W00000X Registered NurseRN253137GA

Practice location

1405 Clifton Rd Ne
Atlanta, GA 30322-1060

Phone 262-483-1580

Mailing address

Po Box 110566
Durham, NC 27709-5566

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

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