Provider Demographics
NPI:1760103154
Name:LUMSDEN, MARK ANTHONY (CAA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:LUMSDEN
Suffix:
Gender:M
Credentials:CAA
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Mailing Address - Street 1:3457 DRAYTON MANOR RUN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-9417
Mailing Address - Country:US
Mailing Address - Phone:201-406-1133
Mailing Address - Fax:
Practice Address - Street 1:1700 MEDICAL WAY
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2195
Practice Address - Country:US
Practice Address - Phone:707-979-0200
Practice Address - Fax:678-352-4322
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant