Provider Demographics
NPI:1235223702
Name:GATLIN, STEPHEN B (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:B
Last Name:GATLIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601888
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1888
Mailing Address - Country:US
Mailing Address - Phone:704-246-2777
Mailing Address - Fax:704-246-2788
Practice Address - Street 1:6030 HWY 74 WEST
Practice Address - Street 2:SUITE A
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-3469
Practice Address - Country:US
Practice Address - Phone:704-246-2777
Practice Address - Fax:704-246-2788
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101047363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2760524NMedicare PIN
NC2760524CMedicare PIN
NCNC0216BMedicare PIN
NC2760524HMedicare PIN
NC2760524IMedicare PIN
NCNC0216AMedicare PIN
NC2760524QMedicare PIN
NC2760524RMedicare PIN
NC2760524AMedicare PIN
NC2760524KMedicare PIN
NC2760524EMedicare PIN
NCR40492Medicare UPIN
NC2760524JMedicare PIN