Healthcare Provider Details

I. General information

NPI: 1366852063
Provider Name (Legal Business Name): CYNTHIA DIANE STOVER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CYNTHIA D WHITAKER

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 WHEELER RD STE 365
AUGUSTA GA
30909-6549
US

IV. Provider business mailing address

410 UNIVERSITY PKWY STE 2300
AIKEN SC
29801-6807
US

V. Phone/Fax

Practice location:
  • Phone: 706-432-6866
  • Fax:
Mailing address:
  • Phone: 803-335-1219
  • Fax: 803-335-1689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0007593
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2103
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4313
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8679
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: