Individual
MANDY C STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1700 TREE LN, SUITE 170, SNELLVILLE, GA 30078-6782
(770) 962-0399
(678) 252-3722
Mailing address
755 WALTHER RD, LAWRENCEVILLE, GA 30045-8725
(770) 962-0399
(678) 252-3722
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
003919
GA
Other
Enumeration date
01/26/2007
Last updated
03/21/2008
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