Stanley A Agbulos, PA-C, AA-C
Physician Assistant in Waycross, GA. Individual provider (NPI-1).
NPI number1861477648
StatusActive
Last updated in NPPESFeb 28, 2011
Details
- NPI
- 1861477648
- Entity type
- Individual (NPI-1)
- Name
- Stanley A Agbulos
- Credential
- PA-C, AA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Dec 14, 2005
- Last updated
- Feb 28, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 005073 | GA | Yes |
| 363A00000X | Physician Assistant | PA16336 | CA | |
| 367H00000X | Anesthesiologist Assistant | 005073 | GA |
Practice location
410 Darling AveWaycross, GA 31501-5246
Phone 912-338-6511 · Fax 912-338-6512
Mailing address
Po Box 18824Greensboro, NC 27419-8824
Phone 336-553-1659 · Fax 336-553-3994
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