Provider Demographics
NPI:1396180030
Name:SOUTAR, AARON M (PA)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:M
Last Name:SOUTAR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5501 ABERCORN ST
Mailing Address - Street 2:STE D BOX 104
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6913
Mailing Address - Country:US
Mailing Address - Phone:912-232-9700
Mailing Address - Fax:912-748-0270
Practice Address - Street 1:5356 REYNOLDS ST STE 201
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6019
Practice Address - Country:US
Practice Address - Phone:912-232-9700
Practice Address - Fax:912-748-0270
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006799363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003134446AMedicaid
GA006799OtherMEDICAL LICENSE
GA003134446AMedicaid