Provider Demographics
NPI:1518925767
Name:SIPSY, LONNIE K (DO)
Entity Type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:K
Last Name:SIPSY
Suffix:
Gender:M
Credentials:DO
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 459
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:GA
Mailing Address - Zip Code:30628-0459
Mailing Address - Country:US
Mailing Address - Phone:706-788-3234
Mailing Address - Fax:706-788-2936
Practice Address - Street 1:11 CHARLIE MORRIS RD
Practice Address - Street 2:
Practice Address - City:COLBERT
Practice Address - State:GA
Practice Address - Zip Code:30628-2445
Practice Address - Country:US
Practice Address - Phone:706-788-2127
Practice Address - Fax:706-788-2815
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA55436207R00000X
WV1568207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV6202BOtherMEDICARE PTAN
WVWV6202COtherMEDICARE PTAN
WVWV6202COtherMEDICARE PTAN