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Organization
STILLWELL MEDICAL GROUP
Active
Organization
STILLWELL MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATONDRA DENISE BARKER (MANAGER)
(678) 557-0207
Entity
Organization
Contact information
Practice address
4160 LOGAN DR UNIT 1596, LOGANVILLE, GA 30052-9516
(678) 557-0207
Mailing address
4160 LOGAN DR #1596, LOGANVILLE, GA 30052
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
—
—
363A00000X
Physician Assistant
Primary
3135
GA
Other
Enumeration date
02/14/2007
Last updated
02/04/2016
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