Stout, Bobby Gene
Stout, Bobby Gene is an individual health care provider with primary practice located at 631 Professional Dr Ste 360 , Lawrenceville GA 30046-3370. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Stout, Bobby Gene can be contacted via phone (678) 312-2700.Contact Information
Primary practice address
631 Professional Dr Ste 360
Lawrenceville GA 30046-3370
Phone: (678) 312-2700
Fax: (678) 312-2730
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 003770 | Georgia |
Profile Details
| NPI number | 1235128612 |
|---|---|
| LBN Legal business name | Stout, Bobby Gene |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 18th, 2005 |
| Last updated | Mar 4th, 2020 - about 4 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1235128612 | NPPES |
| Georgia | MEDICAID | 068027283B |
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