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General NPI Number Information
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NPI Number | 1942279294
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Entity Type | Individual
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Provider Name | LINDSEY D BOOKHARDT P.A.
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Gender | Female
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1007 S MACON ST
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City | JESUP
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State | GA
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Zip | 31545-0242
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Country | US
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Telephone | 912-588-1020
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Fax | 912-588-1002
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Provider Business Mailing Address
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Address Line | PO BOX 664
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City | JESUP
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State | GA
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Zip | 31598-0664
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Country | US
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Telephone | 912-588-1020
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Fax | 912-588-1002
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 004294
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License Number State | GA
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