Provider Demographics
NPI:1588721393
Name:MUTZ, STACEY K (PA-C)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:K
Last Name:MUTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1550 MULKEY RD
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1112
Mailing Address - Country:US
Mailing Address - Phone:404-446-1440
Mailing Address - Fax:770-732-2081
Practice Address - Street 1:1550 MULKEY RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1112
Practice Address - Country:US
Practice Address - Phone:404-446-1440
Practice Address - Fax:770-732-2081
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA004409363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical