# STILLWELL MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659414175
- **Authorized official:** LATONDRA DENISE BARKER (MANAGER)
- **Authorized official phone:** (678) 557-0207

## Contact information

- **Practice address:** 4160 LOGAN DR UNIT 1596, LOGANVILLE, GA 30052-9516
- **Practice address phone:** (678) 557-0207
- **Mailing address:** 4160 LOGAN DR \#1596, LOGANVILLE, GA 30052

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 246ZC0007X | Surgical Assistant | — | — | — |
| 363A00000X | Physician Assistant | 3135 | GA | Yes |

## Other

- **Enumeration date:** 02/14/2007
- **Last updated:** 02/04/2016