Healthcare Provider Details

I. General information

NPI: 1033679808
Provider Name (Legal Business Name): MICAH GARRETT LINDSEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 STONERIDGE DR S STE 100
RUCKERSVILLE VA
22968-3096
US

IV. Provider business mailing address

PO BOX 746550
ATLANTA GA
30374-6550
US

V. Phone/Fax

Practice location:
  • Phone: 434-654-1850
  • Fax: 844-328-7646
Mailing address:
  • Phone: 888-236-2263
  • Fax: 844-328-7646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberUO6802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: