Individual
MR. BOBBY GENE STOUT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2200 MEDICAL CENTER BLVD STE 350, LAWRENCEVILLE, GA 30046-7768
(678) 312-2700
(678) 312-2730
Mailing address
PO BOX 2205, LOGANVILLE, GA 30052-0050
(678) 312-2700
(678) 312-2730
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003770
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
068027283B
—
GA
Enumeration date
10/18/2005
Last updated
06/04/2025
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