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NPI Code Detail

MEDICARE: TIMOTHY RAY LUSCHEN PA

MEDICARE: TIMOTHY RAY LUSCHEN PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant002789GA

General Provider Information

NPI Number : 1245281989
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY RAY LUSCHEN PA
Provider Business Mailing Address
First Line : 623 S HOUSTON LAKE RD
Second Line : SUITE 200
City : WARNER ROBINS
State : GA
Zip : 31088-9093
Country : US
Telephone Number : 478-923-6633
Fax Number : 478-923-8444
Provider Business Practice Location Address
First Line : 623 S HOUSTON LAKE RD
Second Line : SUITE 200
City : WARNER ROBINS
State : GA
Zip : 31088-9093
Country : US
Telephone Number : 478-923-6633
Fax Number : 478-923-8444
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2006
Last Update Date : 08/18/2014

Similar Medicare Providers

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1992751911 — MIDDLE GEORGIA MEDICAL ASSOCIATES, P.C.
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1225372329 — WARNER ROBINS MEDICAL CLINIC, PC
Practice Location Address:
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Directions to “ TIMOTHY RAY LUSCHEN PA” Practice Location

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