Healthcare Provider Details

I. General information

NPI: 1942279294
Provider Name (Legal Business Name): LINDSEY D BOOKHARDT P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 S MACON ST
JESUP GA
31545-0242
US

IV. Provider business mailing address

PO BOX 664
JESUP GA
31598-0664
US

V. Phone/Fax

Practice location:
  • Phone: 912-588-1020
  • Fax: 912-588-1002
Mailing address:
  • Phone: 912-588-1020
  • Fax: 912-588-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number004294
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: