Provider Demographics
NPI:1003928193
Name:GRAMER, LINDSAY C (PAAA)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:C
Last Name:GRAMER
Suffix:
Gender:F
Credentials:PAAA
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:A
Other - Last Name:CARBONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAAA
Mailing Address - Street 1:5514 HIGHLAND PRESERVE DR
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-7619
Mailing Address - Country:US
Mailing Address - Phone:404-694-2893
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1443367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA32BBBWJOtherMEDICARE GA
GA683174749AMedicaid