Individual
MARY MICHAELS STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
158 W PONCE DE LEON AVE, DECATUR, GA 30030-2527
(404) 251-2200
Mailing address
158 W PONCE DE LEON AVE, DECATUR, GA 30030-2527
(404) 251-2200
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
88315
GA
Other
Enumeration date
03/17/2018
Last updated
08/25/2021
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