Provider Demographics
NPI:1033143060
Name:LUMPKIN, ANITRICIA DENISE (DO)
Entity Type:Individual
Prefix:
First Name:ANITRICIA
Middle Name:DENISE
Last Name:LUMPKIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANITRA
Other - Middle Name:DENISE
Other - Last Name:LUMPKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2908 MCGEHEE RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2103
Mailing Address - Country:US
Mailing Address - Phone:334-229-9955
Mailing Address - Fax:334-649-8145
Practice Address - Street 1:2908 MCGEHEE RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2103
Practice Address - Country:US
Practice Address - Phone:334-229-9955
Practice Address - Fax:334-649-8145
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADO.000044207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1238431Medicaid
LAP00962663OtherRRMCARE THRU PEPA
LA1238431Medicaid