Doctor Name: | STEPHEN B GATLIN |
NPI Number: | 1235223702 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 101047 |
Business Practice Address: | 6030 Hwy 74 West Suite A Indian Trail, NC - 280793469 |
Business Phone Number: | 7042462777 |
Business Fax Number: | 7042462788 |
Mailing Address: | Po Box 601888, CHARLOTTE |
State: | NC |
Postal Code: | 282601888 |
Phone Number: | 7042462777 |
Fax Number: | 7042462788 |
NPI Enumeration Date: | 10/02/2006 |
NPI Last Update Date: | 06/23/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 101047 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |