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NPI Code Detail

MEDICARE: CYNTHIA SUSAN LAKE

MEDICARE: CYNTHIA SUSAN LAKE
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
1104100000XSocial WorkerCSW003225GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255315842
Entity Type Code : Individual
Provider Name (Legal Business Name) : CYNTHIA SUSAN LAKE
Provider Business Mailing Address
First Line : 3813 PINE KNOLL CT
Second Line :
City : MARTINEZ
State : GA
Zip : 30907-2820
Country : US
Telephone Number : 706-868-1547
Fax Number :
Provider Business Practice Location Address
First Line : 3421 MIKE PADGETT HWY
Second Line :
City : AUGUSTA
State : GA
Zip : 30906-3815
Country : US
Telephone Number : 706-432-4872
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2005
Last Update Date : 03/27/2012

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Directions to “ CYNTHIA SUSAN LAKE ” Practice Location

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