Provider Demographics
NPI:1497160121
Name:LENICHEK, MEREDITH GRACE (PA-C)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:GRACE
Last Name:LENICHEK
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 1:3005 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-6833
Mailing Address - Country:US
Mailing Address - Phone:423-292-5295
Mailing Address - Fax:
Practice Address - Street 1:4717 US HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-2943
Practice Address - Country:US
Practice Address - Phone:912-898-2227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7556363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant