Provider Demographics
NPI:1033679808
Name:LINDSEY, MICAH GARRETT
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:GARRETT
Last Name:LINDSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746550
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6550
Mailing Address - Country:US
Mailing Address - Phone:888-236-2263
Mailing Address - Fax:844-328-7646
Practice Address - Street 1:140 STONERIDGE DR S STE 100
Practice Address - Street 2:
Practice Address - City:RUCKERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22968-3096
Practice Address - Country:US
Practice Address - Phone:434-654-1850
Practice Address - Fax:844-328-7646
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO6802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine