Provider Demographics
NPI:1407098189
Name:ABERNETHY, LINDSAY T (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:T
Last Name:ABERNETHY
Suffix:
Gender:F
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 1:14089 ABERCORN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1966
Mailing Address - Country:US
Mailing Address - Phone:912-350-2121
Mailing Address - Fax:912-350-2145
Practice Address - Street 1:14089 ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1966
Practice Address - Country:US
Practice Address - Phone:912-350-2121
Practice Address - Fax:912-350-2145
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006851363A00000X
KS15-01302363AM0700X
TN1770363A00000X
MN10906363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003145002CMedicaid
GA003145002AMedicaid
TN1031975002OtherCAHABA MEDICARE
GA003145002BMedicaid
GAP01304946OtherRAILROAD MEDICARE
TN1516444Medicaid
TN1516444Medicaid
GA202I975118Medicare PIN