STACEY K MUTZ (NPI# 1588721393) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588721393 |
| Entity Type | Individual |
| Full Name | STACEY K MUTZ |
| Credential | PA-C |
| Practice Address |
1550 Mulkey Rd Austell GA 30106-1112 |
| Practice Telephone | 4044461440 |
| Practice Fax Number | 7707322081 |
| Mailing Telephone | 4044461440 |
| Mailing Fax Number | 7707322081 |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
004409 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1550 MULKEY RD |
| City | AUSTELL |
| State | GA |
| Zip Code | 30106-1112 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720189293 | Janice Murphy Warner | Dermatology | 1550 Mulkey Rd, Austell, GA 30106 | 2006-09-26 |
| 1710220249 | Catherine Gupta Warner | Dermatology | 1550 Mulkey Rd, Austell, GA 30106 | 2013-04-03 |
| 1174680979 | Atlanta West Dermatology, P.C. | Dermatology | 1550 Mulkey Rd, Austell, GA 30106-1112 | 2007-01-02 |
| 1184781999 | Patrick Derouen | Physician Assistant | 1550 Mulkey Rd, Austell, GA 30106-1112 | 2007-01-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073126231 | Courtney Lashune Dorsett | Nurse Practitioner | 1005 Cureton Drive, Austell, Austell, GA 30106 | 2020-08-27 |
| 1184240491 | Brian H Eves | Dietitian, Registered | 3972 Brantley Drive, Austell, GA 30106 | 2020-06-23 |
| 1669014486 | Jesse Mccoy | Registered Nurse | 3950 Austell Rd., Austell, GA 30106 | 2019-10-14 |
| 1427522820 | Envision Optics LLC | Optometrist | 1680 E West Connector, Austell, GA 30106 | 2019-01-18 |
| 1972042380 | Thomas Dental Group | Clinic/Center | 1133 East West Connector, Suite 120, Austell, GA 30106 | 2017-02-17 |
| 1245779792 | Colton Dental Group | Clinic/Center | 2495 East-west Connector, Ste 60, Austell, GA 30106 | 2017-02-16 |
| 1144691684 | Georgia Dental Professionals, PC | Dentist | 780 East West Connector Sw, Suite 108, Austell, GA 30106 | 2015-10-09 |
| 1285013714 | Ikeade Bello Alamu | Nurse Practitioner | 2870 Betula Drive, Austell, GA 30106 | 2015-05-29 |
| 1376922211 | Jessica Williams | Obstetrics & Gynecology | 1700 Hospital South Dr Ste 500, Austell, GA 30106 | 2015-05-26 |
| 1558799593 | Tonya Renee Baldwin | Speech-Language Pathologist | 4229 Brass Trl., Austell, GA 30106 | 2013-10-30 |
| Find all providers in zip 30106 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164057881 | Aimberly Reshea Sanders | Physician Assistant | 1700 Hospital South Dr Ste 502, Austell, GA 30106-8159 | 2020-03-04 |
| 1013568104 | Lauren Blessing | Physician Assistant | 1700 Hospital South Dr Ste 300, Austell, GA 30106-8116 | 2019-09-20 |
| 1588118483 | Megan Rutherford Gaskin | Physician Assistant | 3820 Medical Park Dr, Austell, GA 30106-1110 | 2016-08-08 |
| 1740556380 | Richard St. Charles | Physician Assistant | 3820 Medical Park Drive, Austell, GA 30106 | 2012-03-28 |
| 1467770156 | Amber H Herring | Physician Assistant | 3820 Medical Park Dr, Austell, GA 30106-1110 | 2010-05-06 |
| 1205161965 | Meghan R Kirkland | Physician Assistant | 3820 Medical Park Dr, Austell, GA 30106-1110 | 2009-10-13 |
| 1093955395 | M. Luisa C Bowzard | Physician Assistant | 3820 Medical Park Dr, Austell, GA 30106-1110 | 2009-02-26 |
| 1316187610 | Shari A Seaman | Physician Assistant | 3820 Medical Park Dr, Austell, GA 30106-1110 | 2009-02-26 |
| 1700030624 | Kathy S Poodiack | Physician Assistant | 1700 Hospital South Drive, Suite 300, Austell, GA 30106-8116 | 2008-11-05 |
| 1184781999 | Patrick Derouen | Physician Assistant | 1550 Mulkey Rd, Austell, GA 30106-1112 | 2007-01-02 |
| Find all providers in AUSTELL | ||||
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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.