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General NPI Number Information
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NPI Number | 1235215328
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Entity Type | Individual
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Provider Name | VALENCIA WILSON LOCKHART PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7950 MARTIN LOOP
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City | FORT BENNING
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State | GA
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Zip | 31905-5647
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Country | US
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Telephone | 706-544-1123
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Fax |
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Provider Business Mailing Address
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Address Line | 239 LEE ROAD 665
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City | AUBURN
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State | AL
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Zip | 36832-8805
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Country | US
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Telephone | 334-821-4421
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA175
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License Number State | AL
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