Healthcare Provider Details

I. General information

NPI: 1831357896
Provider Name (Legal Business Name): LINDSAY S FRETTS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 ROSS CLARK CIR BLDG SUITE704
DOTHAN AL
36301-3001
US

IV. Provider business mailing address

PO BOX 1928
DOTHAN AL
36302-1928
US

V. Phone/Fax

Practice location:
  • Phone: 334-712-3738
  • Fax: 334-699-4897
Mailing address:
  • Phone: 334-793-8087
  • Fax: 334-793-8191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number585
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-585
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: