Provider Demographics
NPI:1548570120
Name:STOUGH, CHAD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:
Last Name:STOUGH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:915 THORNTON ROAD
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122
Mailing Address - Country:US
Mailing Address - Phone:770-739-9292
Mailing Address - Fax:770-948-9126
Practice Address - Street 1:2713 MARIETTA HIGHWAY
Practice Address - Street 2:SUITE 122
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157
Practice Address - Country:US
Practice Address - Phone:770-505-3162
Practice Address - Fax:770-948-9126
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA004763363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant