Provider Demographics
NPI:1083199731
Name:LEFKOVIC, KEVIN (PA-C)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:LEFKOVIC
Suffix:
Gender:M
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:PO BOX 741620
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1620
Mailing Address - Country:US
Mailing Address - Phone:843-764-1730
Mailing Address - Fax:
Practice Address - Street 1:9300 MEDICAL PLAZA DR STE B
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9334
Practice Address - Country:US
Practice Address - Phone:843-764-1730
Practice Address - Fax:843-764-1731
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant