Provider Demographics
NPI:1548536022
Name:DENICE STARLEY, DO, LLC
Entity type:Organization
Organization Name:DENICE STARLEY, DO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENICE
Authorized Official - Middle Name:
Authorized Official - Last Name:STARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-622-7983
Mailing Address - Street 1:132 W POINT PLANTATION PKWY
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-5834
Mailing Address - Country:US
Mailing Address - Phone:702-622-7983
Mailing Address - Fax:912-434-6061
Practice Address - Street 1:256 SCRANTON CONNECTOR STE 112
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-0557
Practice Address - Country:US
Practice Address - Phone:702-622-7983
Practice Address - Fax:912-434-6061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0656182081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA065618OtherGEORGIA MEDICAL LICENSE