Provider Demographics
NPI:1003254863
Name:LOTSON, FALLON E (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:FALLON
Middle Name:E
Last Name:LOTSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 13TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-2596
Mailing Address - Country:US
Mailing Address - Phone:706-243-7010
Mailing Address - Fax:705-243-7019
Practice Address - Street 1:2300 13TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2596
Practice Address - Country:US
Practice Address - Phone:706-243-7010
Practice Address - Fax:705-243-7019
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006822363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant