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MR. STANLEY BRUCE ALLEN PAC

>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1326034505

Individual Registrant:
MR. STANLEY BRUCE ALLEN PAC
Gender: M
Not Sole Proprietor

Location and contact information for practice:
2621 E PINETREE BLVD  THOMASVILLE, GA 31792-4840 US
Tel: 229-584-4100  Fax: --

Contact information for business:
900 CAIRO RD  THOMASVILLE, GA 31792-4255 US
Tel: --  Fax: --

Registration Information:
NPI: 1326034505
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
GA001731

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
100000109BGA05
RAILROAD MEDICARE970029019GA01
MEDICARE GROUPGRP7061GA01




HEALTH CARE JOBS GA - Page 1



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