Healthcare Provider Details

I. General information

NPI: 1285878165
Provider Name (Legal Business Name): ELIZABETH LEE LOWRY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH NICOLE LEE PA-C

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 SHERATON BLVD
MACON GA
31210-1358
US

IV. Provider business mailing address

240 SHERATON BLVD
MACON GA
31210-1358
US

V. Phone/Fax

Practice location:
  • Phone: 478-471-1943
  • Fax: 478-475-3726
Mailing address:
  • Phone: 478-633-8400
  • Fax: 478-633-4295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005579
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: