Healthcare Provider Details

I. General information

NPI: 1245262153
Provider Name (Legal Business Name): LINDSAY N. M. OWEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSAY NICOLE MOORING PA-C

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 DEP BILL CANTRELL MEMORIAL RD
CUMMING GA
30040-3011
US

IV. Provider business mailing address

3970 DEP BILL CANTRELL MEMORIAL RD
CUMMING GA
30040-3011
US

V. Phone/Fax

Practice location:
  • Phone: 678-513-2273
  • Fax: 678-513-8869
Mailing address:
  • Phone: 678-513-2273
  • Fax: 678-513-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number004788
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: