Provider Demographics
NPI:1043205388
Name:LEKAS, JAMES B (PAC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:LEKAS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 BELLEVUE RD
Mailing Address - Street 2:SUITE 21-A
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2885
Mailing Address - Country:US
Mailing Address - Phone:478-275-7202
Mailing Address - Fax:478-274-8418
Practice Address - Street 1:1157 FORSYTH ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7452
Practice Address - Country:US
Practice Address - Phone:478-745-8581
Practice Address - Fax:478-328-0438
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002431363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00168001OtherRAILROAD MEDICARE
GADC4061OtherRAILROAD MEDICARE
GA100002523BMedicaid
GA97WCFZBMedicare PIN
GADC4061OtherRAILROAD MEDICARE
GAP00168001OtherRAILROAD MEDICARE