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LELA FAIRCLOTH ALLEN PA-C
>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1104024777
Individual Registrant: LELA FAIRCLOTH ALLEN PA-C
Gender: F
Not Sole Proprietor
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
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
Tel: 229-433-7200 Fax: 229-249-4031
Registration Information:
NPI: 1104024777
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers Physician Assistant | GA | 003754 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 622508818C | GA | 05 |
