Individual
KEMBERLY AMANDA STONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
453 LAKES BLVD SUITE B, LAKE PARK FAMILY CARE CLINIC, LAKE PARK, GA 31636
(229) 588-2866
Mailing address
453 LAKES BLVD, SUITE B, LAKE PARK, GA 31636-6607
(229) 588-2866
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
05480
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05480
GEORGIA MEDICAL LICENSE NUMBER: 05480 EXPIRATION 01/31/2016
GA
Enumeration date
03/06/2007
Last updated
03/02/2018
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