Stillwell Medical Group

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

3135 Issued in GA

Legal business name

STILLWELL MEDICAL GROUP

Practice address

4160 Logan Dr Unit 1596
Loganville, GA 30052-9516

Phone

(678) 557-0207

NPI assigned

Feb 14, 2007

Last updated

Feb 4, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Latondra Denise Barker

Title

Manager

Phone

(678) 557-0207

Specialties & licenses 2

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Eddie L Whitehead, MD

  • Internal Medicine Physician
  • Tucker, GA
  • NPI 1669516795
  NPD (past)
• Latondra Stillwell-Barker, DMSC, PA-C

  • Physician Assistant
  • Fayetteville, NC
  • NPI 1245398221

  Surgical Assistant

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454544000000",
    "number": "1659414175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4160 LOGAN DR #1596",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "30052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4160 LOGAN DR UNIT 1596",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300529516",
            "telephone_number": "678-557-0207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STILLWELL MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2016-02-04",
        "status": "A",
        "authorized_official_last_name": "BARKER",
        "authorized_official_first_name": "LATONDRA",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "678-557-0207"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "3135",
            "primary": true
        },
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Tara Stancel, CPNP
• Kimberly Stanton, RN
• Alyssa Hope Stewart, MS
• Amanda Kleweno Stewart, PT
• Lashauna Stewart
• Joann Yamile Stvil, RN
• Surgicare Gwinnett
• Surgicare Plus LLC
• Sweet Peach Blossom, a Mindfulness Practice
• Thenethong Sybangone, CNA

• Physician Assistant in Loganville, GA
• Providers in Loganville, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.