Individual
ALYSSA STOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
4300 UNIVERSITY PKWY, EVANS, GA 30809-3063
(706) 721-8623
Mailing address
1120 15TH ST STE BI-1056, AUGUSTA, GA 30912-0004
(706) 721-3813
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
2626
MN
2255A2300X
Athletic Trainer
Primary
AT003333
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AT003333
ATHLETIC TRAINER LICENSE
GA
Enumeration date
05/16/2016
Last updated
03/25/2020
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