Agbulos, Stanley A

Agbulos, Stanley A is an individual health care provider with primary practice located at 410 Darling Ave , Waycross GA 31501-5246. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Anesthesiologist Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Agbulos, Stanley A can be contacted via phone (912) 338-6511.

Contact Information

Primary practice address
410 Darling Ave Waycross GA 31501-5246
Phone: (912) 338-6511
Fax: (912) 338-6512
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA16336 California
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 005073 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Anesthesiologist Assistant 367H00000X 005073 Georgia

Profile Details

NPI number 1861477648
LBN Legal business name Agbulos, Stanley A
Credentials PA-C, AA-C
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 14th, 2005
Last updated Feb 28th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861477648 NPPES
Georgia MEDICAID 259983019A
Georgia Other P00410142
Georgia MEDICAID PA16336

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