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General NPI Number Information
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NPI Number | 1962554451
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Entity Type | Individual
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Provider Name | MR. LEMONT C MONROE SR.
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Gender | Male
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1916 N LEG RD
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City | AUGUSTA
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State | GA
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Zip | 30909-4402
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Country | US
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Telephone | 706-667-4283
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Fax | 706-729-2053
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Provider Business Mailing Address
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Address Line | 1916 N LEG RD
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City | AUGUSTA
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State | GA
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Zip | 30909-4402
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Country | US
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Telephone | 706-667-4283
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Fax | 706-729-2053
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN045602
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License Number State | GA
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