Individual provider · Type 1 NPI
Teresa Boutwell, CST
Medical Physician Assistant · Oxford, GA
NPI number
1669543203
Active
Practice location
70 Ashford Dr
Oxford, GA 30054-4648
Fax (770) 985-4258
Mailing address
PO Box 1938
Conyers, GA 30012-7291
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Medical Physician Assistant Primary | 363AM0700X | 91956 (GA) |
Medical Physician Assistant: Definition to come...
Another provider at this address
About NPI 1669543203
Teresa Boutwell, CST's National Provider Identifier is 1669543203, issued on Nov 13, 2006. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Oxford, GA. The record was last updated on Jul 8, 2007.