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Contact Information

STILLWELL MEDICAL GROUP
4160 LOGAN DR UNIT 1596
LOGANVILLE, GA30052-9516
 Phone: 678-557-0207
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Surgical Assistant

246ZC0007X
Indicates primary specialty

NPI Profile & details for STILLWELL MEDICAL GROUP

NPI # 1659414175
LBN Legal business name STILLWELL MEDICAL GROUP
Authorized official LATONDRA BARKER - (MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 02/14/2007
Last updated 02/04/2016 - About 10 years ago
Identifiers
GA License # 3135
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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