Individual
KEIKO STOBAEUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1120 15TH ST, AU NEPHROLOGY BA-9413, AUGUSTA, GA 30912
(706) 721-2861
Mailing address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-1886
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
01/09/2019
Last updated
01/09/2020
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