Provider Demographics
NPI:1780663351
Name:LUNSFORD, REBECCA (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:LUNSFORD
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 1:3300 OLD MILTON PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-2428
Mailing Address - Country:US
Mailing Address - Phone:404-255-1933
Mailing Address - Fax:404-785-9102
Practice Address - Street 1:3300 OLD MILTON PKWY STE 310
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-2428
Practice Address - Country:US
Practice Address - Phone:404-255-1933
Practice Address - Fax:404-785-9102
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4047363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant