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General NPI Number Information
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NPI Number | 1871584417
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Entity Type | Individual
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Provider Name | LESTER DARRELL LEGGETTE PA-AA
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Gender | Male
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 380 HOSPITAL DR SUITE 410
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City | MACON
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State | GA
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Zip | 31217
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Country | US
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Telephone | 478-746-5644
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Fax | 229-434-2502
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Provider Business Mailing Address
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Address Line | PO BOX 2564
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City | MACON
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State | GA
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Zip | 31203-2565
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Country | US
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Telephone | 478-746-5644
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Fax | 478-745-4849
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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 | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | 001796
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License Number State | GA
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