MR. BOBBY GENE STOUT JR. (NPI# 1235128612) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235128612 |
| Entity Type | Individual |
| Full Name | MR. BOBBY GENE STOUT JR. |
| Credential | PA-C |
| Practice Address |
631 Professional Dr Ste 360 Lawrenceville GA 30046-3370 |
| Mailing Address |
Po Box 2205 Loganville GA 30052-0050 |
| Practice Telephone | 6783122700 |
| Practice Fax Number | 6783122730 |
| Mailing Telephone | 6786140900 |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2020-03-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 003770 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 068027283B | 05 |
| Street Address |
631 PROFESSIONAL DR STE 360 |
| City | LAWRENCEVILLE |
| State | GA |
| Zip Code | 30046-3370 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457740516 | Nisha Patel | Physician Assistant | 631 Professional Dr Ste 360, Lawrenceville, GA 30046-3370 | 2015-01-13 |
| 1558795229 | Marguerite Horen Bobon | Nurse Practitioner | 631 Professional Dr Ste 360, Lawrenceville, GA 30046-3370 | 2013-08-29 |
| 1750722484 | Avital Perry | Neurological Surgery | 631 Professional Dr Ste 360, Lawrenceville, GA 30046-3370 | 2013-07-10 |
| 1538426549 | Evan Kyle Winograd | Neurological Surgery | 631 Professional Dr Ste 360, Lawrenceville, GA 30046-3370 | 2012-04-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063023174 | Alpha & Omega Hearing Centers | Hearing Instrument Specialist | Alpha & Omega Hearing Centers, 250 Langley Drive, Suite 1106, Lawrenceville, GA 30046 | 2020-08-12 |
| 1285259846 | Mesun Health Services, Inc | Clinical Nurse Specialist | 88 Johnson Rd Building # 1-b, Lawrenceville, GA 30046 | 2020-06-10 |
| 1215550264 | Mesun Health Services, Inc | Skilled Nursing Facility | 88 Johnson Rd. Building #2, Lawrenceville, GA 30046 | 2020-05-26 |
| 1306499785 | Bryan Acosta | Chiropractor | 471 Scenic Hwy South, Lawrenceville, GA 30046 | 2019-07-24 |
| 1205308616 | Belle Lumiere Cosmetics LLC | Dermatology | 753 Old Norcross Road, Lawrenceville, GA 30046 | 2018-12-24 |
| 1548730179 | Alexis Nicole Robinson | Nurse Anesthetist, Certified Registered | 1000 Medical Center Boulevard, Lawrenceville, GA 30046 | 2018-11-27 |
| 1679060388 | Christopher Puckett | Student in an Organized Health Care Education/Training Program | 665 Duluth Hwy Suite 501, Lawrenceville, GA 30046 | 2018-04-18 |
| 1457851255 | Advanced Urology Institute of Georgia | Urology | 501 Crown Point Way, Lawrenceville, GA 30046 | 2018-02-19 |
| 1013447044 | Pharmacy Investments of Lawrenceville, LLC | Pharmacy | 738 Old Norcross Road, Ste A, Lawrenceville, GA 30046 | 2017-06-13 |
| 1225577000 | Priority Housecalls LLC | Clinic/Center | 225 Scenic Hwy, Ste 200, Lawrenceville, GA 30046 | 2017-02-14 |
| Find all providers in zip 30046 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184241879 | Victoria I Nwadiogbu | Physician Assistant | 1664 Hampton Hollow Trl, Lawrenceville, GA 30043-5176 | 2020-06-29 |
| 1588294441 | Dat Nguyen | Physician Assistant | 771 Old Norcross Rd Ste 355, Lawrenceville, GA 30046-4324 | 2020-01-20 |
| 1679132153 | Tatiana Tulei | Physician Assistant | 1571 Swan Valley Ct, Lawrenceville, GA 30043-7410 | 2019-06-10 |
| 1740751973 | Cheryl Dawn Tioaquen | Physician Assistant | 3060 Binghampton Ln, Lawrenceville, GA 30044-2797 | 2018-12-16 |
| 1982188322 | Benjamin J Singleton | Physician Assistant | 2020 Waters Ferry Dr, Lawrenceville, GA 30043-3172 | 2018-09-21 |
| 1629556832 | Elizabeth Chandler Harris | Physician Assistant | 301 Phiip Blvd, Suite A, Lawrenceville, GA 30046-8746 | 2018-07-31 |
| 1972970762 | Christopher James Weigel | Physician Assistant | 758 Old Norcross Rd Ste 100, Lawrenceville, GA 30046-3386 | 2015-08-27 |
| 1679887889 | William Bruce Rice | Physician Assistant | 771 Old Norcross Rd Ste And390, Lawrenceville, GA 30046-4386 | 2010-07-29 |
| 1043459613 | Lashonda Kenya Bloodsaw | Physician Assistant | 1735 N Brown Raod, Health Care Partners, Lawrenceville, GA 30043-3872 | 2009-02-05 |
| 1750320685 | Jerry U. Mercedat | Physician Assistant | 631 Professional Dr Ste 170, Lawrenceville, GA 30046-3392 | 2006-06-06 |
| Find all providers in LAWRENCEVILLE | ||||
| City | LAWRENCEVILLE |
| Zip Code | 30046 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.