Provider Demographics
NPI:1336323401
Name:LASHLEY, JENNIFER L (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:LASHLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:WILLOUGHBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 743294
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3294
Mailing Address - Country:US
Mailing Address - Phone:864-603-6300
Mailing Address - Fax:864-603-6160
Practice Address - Street 1:3 ST. FRANCIS DR. STE. 300
Practice Address - Street 2:PALMETTO PULMONARY AND CRITICAL CARE
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3972
Practice Address - Country:US
Practice Address - Phone:864-233-8063
Practice Address - Fax:864-233-2438
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1280363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0732PAMedicaid
SC0732PAMedicaid