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LELA FAIRCLOTH ALLEN PA-C

>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1104024777

Individual Registrant:
 LELA FAIRCLOTH ALLEN PA-C
Gender: F
Not Sole Proprietor

Location and contact information for practice:
3018 N PATTERSON ST  VALDOSTA, GA 31602-1711 US
Tel: 229-433-7200  Fax: 229-249-4031

Contact information for business:
PO BOX 70  VALDOSTA, GA 31603-0070 US
Tel: 229-433-7200  Fax: 229-249-4031

Registration Information:
NPI: 1104024777
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
GA003754

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
622508818CGA05




HEALTH CARE JOBS GA - Page 1



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