Individual
ALAN STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
612 N PATTERSON ST, VALDOSTA, GA 31601-4610
(706) 980-9975
Mailing address
612 N PATTERSON ST, VALDOSTA, GA 31601-4610
(706) 980-9975
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
026664
GA
207Q00000X
Family Medicine Physician
Primary
026664
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000320526F
—
GA
05
—
000320526G
—
GA
05
—
000320526H
—
GA
01
—
4130194
BCBS OF TENNESSEE
TN
01
—
P00282948
RAILROAD MEDICARE
GA
Enumeration date
06/12/2006
Last updated
07/24/2019
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