Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mandy C Stout, PA-C

Individual provider Medical Physician Assistant · NPI 1578619219

Mandy C Stout, PA-C is a Physician Assistant in Snellville, Georgia. Qualified in 2002, 24 years ago. Practices with Northside Cv Professional Services LLC, a 53-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
24
Licensed in
GA
In the registry since
2007
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1700 Tree Ln Ste 170
Snellville, GA 30078-6782
Phone: (770) 962-0399
Fax: (678) 252-3722
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 003919 (GA)

Record details

NPI number1578619219
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJanuary 26, 2007
Last updated in NPPESMarch 21, 2008
Mailing address755 Walther Rd, Lawrenceville, GA 30045-8725

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2002 (24 years in practice)
Group practice Northside Cv Professional Services Llc — 53 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Snellville