Provider Demographics
NPI:1104010313
Name:LAMPKIN, PEGGY A (PA)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:A
Last Name:LAMPKIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 PEACHTREE ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30434-1449
Mailing Address - Country:US
Mailing Address - Phone:478-625-7597
Mailing Address - Fax:
Practice Address - Street 1:809 PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:GA
Practice Address - Zip Code:30434-1449
Practice Address - Country:US
Practice Address - Phone:478-625-7597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004982363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical