Individual provider · Type 1 NPI

Mandy C. Stout, PA-C

Medical Physician Assistant · Snellville, GA

NPI number 1578619219 Active

Practice location

1700 Tree Ln, Suite 170
Snellville, GA 30078-6782

Call (770) 962-0399 Map

Fax (678) 252-3722

Mailing address

755 Walther Rd
Lawrenceville, GA 30045-8725

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700X003919 (GA)

Medical Physician Assistant: Definition to come...

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About NPI 1578619219

Mandy C. Stout, PA-C's National Provider Identifier is 1578619219, issued on Jan 26, 2007. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Snellville, GA. The record was last updated on Mar 21, 2008.